The Feasibility of Xpert MTB/RIF Testing to Detect Rifampicin Resistance among Childhood Tuberculosis for Prevalence Surveys in Northern China.

Jie Lu,Shujing Han,Yongli Guo,Shunying Zhao,Fang Dong,Yanlin Zhao,Wenqi Song,Jin Shi,Ping Chu,Huimin Li,Hui Yang

doi:10.1155/2017/5857369

Abstract

Drug resistance surveillance is crucial for control of drug-resistant tuberculosis (TB). However, limited data exists on the burden of drug-resistant TB in children. The goal of this work was to generate prevalence data regarding rifampicin- (RIF-) resistant childhood TB in northern China and to test the feasibility of Xpert for surveying pediatric TB drug resistance prevalence. We enrolled 362 clinically diagnosed childhood TB patients and collected sputum, gastric lavage aspirate (GLA), bronchoalveolar lavage fluid (BALF), and cerebral spinal fluid (CSF) samples. Xpert and solid culture were utilized to detect RIF resistance. The detection rate of Xpert-positive TB among new clinically diagnosed TB cases was 38.4% (139/362), significantly higher than that of solid culture-positive TB (16.3%, 59/362, P < 0.01). Notably, Xpert-positive rates differed significantly by sample type, with the highest positive rate for GLA (51.2%). The unit testing costs per RIF-resistant TB patient were $828.41 for solid culture and $761.86 for Xpert. Our data demonstrate that the prevalence of RIF resistance among childhood TB cases in our study (6.9%) is comparable to the national RIF resistance prevalence level of new cases (6.7%). In addition, Xpert is superior to the solid culture for RIF resistance survey in the childhood TB patients.

Highlights

The threat of childhood tuberculosis (TB) is increasingly being recognized as a major public health concern [1, 2]
Our data revealed that Xpert is superior to conventional culture methods, achieving a higher positive detection rate of pediatric TB cases from various clinical samples
The high proportion of gastric lavage aspirate (GLA) samples in this study may be another important cause of low detection rate when using solid culture

Summary

Introduction

The threat of childhood tuberculosis (TB) is increasingly being recognized as a major public health concern [1, 2]. The World Health Organization (WHO) estimates that in 2015 one million new pediatric tuberculosis cases were diagnosed, accounting for approximately 10% of the global TB burden [3]. In settings where TB is endemic, such as India and China, the estimated number of children with this disease constitutes 20% of all active TB cases [2]. Because children with TB will transmit disease to future generations [2], more attention should be devoted to minimizing childhood TB in order to reduce the future overall global TB burden.

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