Xpert MTB/RIF assay for the diagnosis of rifampicin resistance in different regions: a meta-analysis

Kaican Zong,Shiying Li,Yangzhi Jiang,Hui Zhou,Chen Luo

doi:10.1186/s12866-019-1516-5

Abstract

BackgroundTo estimate the diagnostic accuracy of Xpert MTB/RIF for rifampicin resistance in different regions, a meta-analysis was carried out.MethodsSeveral databases were searched for relevant studies up to March 3, 2019. A bivariate random-effects model was used to estimate the diagnostic accuracy.ResultsWe identified 97 studies involving 26,037 samples for the diagnosis of rifampicin resistance. The pooled sensitivity, specificity and AUC of Xpert MTB/RIF for rifampicin resistance detection were 0.93 (95% CI 0.90–0.95), 0.98 (95% CI 0.96–0.98) and 0.99 (95% CI 0.97–0.99), respectively. For different regions, the pooled sensitivity were 0.94(95% CI 0.89–0.97) and 0.92 (95% CI 0.88–0.94), the pooled specificity were 0.98 (95% CI 0.94–1.00) and 0.98 (95% CI 0.96–0.99), and the AUC were 0.99 (95% CI 0.98–1.00) and 0.99 (95% CI 0.97–0.99) in high and middle/low income countries, respectively. The pooled sensitivity were 0.91 (95% CI 0.87–0.94) and 0.91 (95% CI 0.86–0.94), the pooled specificity were 0.98 (95% CI 0.96–0.99) and 0.98 (95% CI 0.96–0.99), and the AUC were 0.98 (95% CI 0.97–0.99) and 0.99 (95% CI 0.97–0.99) in high TB burden and middle/low prevalence countries, respectively.ConclusionsThe diagnostic accuracy of Xpert MTB/RIF for rifampicin resistance detection was excellent.

Highlights

To estimate the diagnostic accuracy of Xpert MTB/RIF for rifampicin resistance in different regions, a meta-analysis was carried out
We identified 97 studies involving 26,037 samples for the diagnosis of rifampicin resistance
The pooled sensitivity, specificity and AUC of Xpert MTB/RIF for rifampicin resistance detection were 0.93, 0.98 and 0.99, respectively

Summary

Introduction

To estimate the diagnostic accuracy of Xpert MTB/RIF for rifampicin resistance in different regions, a meta-analysis was carried out. In 2017, TB infected about 10.0 million people and approximately 16% (1.6 million) of infected patients died from the disease, which was a higher global total for new TB cases and deaths than previous one. Drug-resistant TB, including multidrug-resistant TB (MDR-TB, defined as resistance to at least isoniazid and rifampicin, the two most important first-line antiTB drugs) and extensively drug-resistant TB TB, defined as MDR-TB plus resistance to any fluoroquinolone, such as ofloxacin or moxifloxacin, and to at least one of three injectable second-line drugs, amikacin, capreomycin, or kanamycin) has become a serious threat to global health [2]. In 2017, approximately 460,000 people, which means 3.5% of new and 18% of previously treated TB cases, were estimated to have had MDR-TB globally. Rifampicin resistance (RR) was the most common resistance drug, affected approximately 558,000 people [1]

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