title: Rapid and effective diagnosis of tuberculosis and rifampicin resistance with Xpert MTB/RIF assay: a meta-analysis.
abstract: OBJECTIVE
  Xpert MTB/RIF (Cepheid) assay has been introduced for the diagnosis of tuberculosis (TB) and RIF-resistance. The meta-analysis was used to establish the overall accuracy of Xpert MTB/RIF assay for diagnosing TB and RIF-resistance.
  
  
  METHODS
  Based on comprehensive searches of the Pubmed and Embase, we identified outcome data from all articles estimating diagnostic accuracy with Xpert MTB/RIF assay. A summary estimation for sensitivity, specificity, diagnostic odds ratios (DOR) and the area under the summary ROC curve (AUC) was calculated by using the bivariate random-effects approach.
  
  
  RESULTS
  The meta-analysis included 18 studies (10,224 suspected specimens). The summary estimate was 90.4% (95%CI 89.2%-91.4%) for sensitivity, 98.4% (95%CI 98.0%-98.7%) for specificity and 328.3/0.9822 for DOR/AUC in pulmonary tuberculosis (PTB). The sensitivity, specificity and DOR/AUC of detecting RIF-resistance were 94.1%, 97.0% and 177.8/0.9832, respectively. For extrapulmonary tuberculosis, the overall pooled sensitivity was 80.4% and specificity was 86.1%. The findings in subgroup analysis were as follows: the accuracy of Xpert MTB/RIF assay is higher in smear-positive specimens and the sensitivity of diagnosing PTB in adults was higher than that in children (90.8% versus 74.3%).
  
  
  CONCLUSIONS
  TB and RIF-resistance can be rapidly and effectively diagnosed with Xpert MTB/RIF assay.
authors.affiliation: Department of Clinical Laboratory Medicine, Institute of Surgery Research, Daping Hospital, The Third Military Medical University, Chongqing, China.
authors.forename: Kai
authors.initials: K
authors.lastname: Chang
authors.forename: Weiping
authors.initials: W
authors.lastname: Lu
authors.forename: Junji
authors.initials: J
authors.lastname: Wang
authors.forename: Kejun
authors.initials: K
authors.lastname: Zhang
authors.forename: Shuangrong
authors.initials: S
authors.lastname: Jia
authors.forename: Fake
authors.initials: F
authors.lastname: Li
authors.forename: Shaoli
authors.initials: S
authors.lastname: Deng
authors.forename: Ming
authors.initials: M
authors.lastname: Chen
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000494:pharmacology*; D002648:Child; D002675:Child, Preschool; D024881:Drug Resistance, Bacterial; D006801:Humans; D025202:Molecular Diagnostic Techniques; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000302:isolation & purification*; D011237:Predictive Value of Tests; D012372:ROC Curve; D012293:Rifampin / Q000494:pharmacology*; D012680:Sensitivity and Specificity; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis*
chemical_list: D000995:Antitubercular Agents; D012293:Rifampin