Determining the Prevalence of Rifampicin Resistant Tuberculosis in A Tertiary Care Centre of North India by using Rapid Culture Method and Gene Xpert

Abstract

The objective of the present study is to find the prevalence of Mycobacterium tuberculosis from respiratory samples like sputum, BAL and pleural fluid, compare conventional LJ culture with rapid culture method i.e Mycobacterium growth indicator tube (MGIT) and to determine the pattern of drug resistance by automated methods i.e Gene Xpert. Respiratory samples were collected in sterile, wide-mouth, disposable, leak proof containers without any preservatives. Specimens were inoculated into MGIT for primary isolation of Mycobacteria. The specimen was processed according to the SOP manual provided by Becton Dickinson Company. The tubes were read for increasing fluorescence by MGIT reader. Reported results only when a MGIT tube was positive by the MGIT reader and smear made from the positive broth is also positive for AFB. For further identification, TBcID card test was put from MGIT positive tube and the result was given accordingly as mentioned in the procedure for TBcID kit insert. Polymerase chain reaction (PCR) was done in all 17 positive cases. The drug sensitivity test (CB-NAAT) was done at State Intermediate Reference Laboratory, Chandan Nagar, Dehradun, Uttrakhand as per RNTCP laboratory operational guidelines. In our study total number of samples received from the clinically suspected cases of pulmonary tuberculosis were 156, out of which 11% were positive and 89% were negative. The predominant age group involved was 51-60 years 24%, followed by 61-70 years 22%. In young children and adolescent age group very less number of samples were received i.e. 0-5%. Out of 17 positive samples, 94.11% (16/17) were detected as sensitive for Rifampicin and 5.89% (1/17) were resistant. On the statistical analysis of our data for MGIT, Positive Predictive Value (PPV) was 29% against Negative Predictive Value (NPV) of 100%. The specificity of MGIT was 92% against a sensitivity of 100%. Culture is still needed for species identification, confirmation and drug susceptibility testing. The diagnostic superiority of MGIT, both in terms of sensitivity and specificity has been proven better as compared to LJ in previous other studies and supported by our study as well. In our study, the diagnostic efficacy of MGIT culture was found to be superior as compared to the conventional LJ culture. The positivity rate was 10.89% (17/156) in MGIT & 3.2% (5/156) in LJ culture.