Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis.
Xpert MTB/RIF (Cepheid, Sunnyvale, CA, USA) is endorsed for the detection of pulmonary tuberculosis (TB). We performed a systematic review and meta-analysis to assess the accuracy of Xpert for the detection of extrapulmonary TB. We searched multiple databases to October 15, 2013. We determined the accuracy of Xpert compared with culture and a composite reference standard (CRS). We grouped data by sample type and performed meta-analyses using a bivariate random-effects model. We assessed sources of heterogeneity using meta-regression for predefined covariates. We identified 18 studies involving 4461 samples. Sample processing varied greatly among the studies. Xpert sensitivity differed substantially between sample types. In lymph node tissues or aspirates, Xpert pooled sensitivity was 83.1% (95% CI 71.4-90.7%) versus culture and 81.2% (95% CI 72.4-87.7%) versus CRS. In cerebrospinal fluid, Xpert pooled sensitivity was 80.5% (95% CI 59.0-92.2%) against culture and 62.8% (95% CI 47.7-75.8%) against CRS. In pleural fluid, pooled sensitivity was 46.4% (95% CI 26.3-67.8%) against culture and 21.4% (95% CI 8.8-33.9%) against CRS. Xpert pooled specificity was consistently >98.7% against CRS across different sample types. Based on this systematic review, the World Health Organization now recommends Xpert over conventional tests for diagnosis of TB in lymph nodes and other tissues, and as the preferred initial test for diagnosis of TB meningitis.
Division of Infectious Disease, Beth Israel Deaconess Medical Centre, Boston, MA, USA McGill International TB Centre, and Dept of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada claudia.denkinger@mail.mcgill.ca.
Claudia M
CM
Denkinger
McGill International TB Centre, and Dept of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.
Samuel G
SG
Schumacher
Foundation for Innovative New Diagnostics, Geneva, Switzerland.
Catharina C
CC
Boehme
McGill International TB Centre, and Dept of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, Montreal, QC, Canada.
Nandini
N
Dendukuri
McGill International TB Centre, and Dept of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, Montreal, QC, Canada.
Madhukar
M
Pai
Portland, OR, USA.
Karen R
KR
Steingart
D000904:Antibiotics, Antitubercular / Q000627:therapeutic use; D016208:Databases, Factual; D024881:Drug Resistance, Bacterial; D015658:HIV Infections / Q000150:complications; D006801:Humans; D025202:Molecular Diagnostic Techniques; D009169:Mycobacterium tuberculosis / Q000235:genetics; D015995:Prevalence; D012015:Reference Standards; D012044:Regression Analysis; D015203:Reproducibility of Results; D012293:Rifampin / Q000627:therapeutic use; D012680:Sensitivity and Specificity; D014376:Tuberculosis / Q000175:diagnosis* / Q000628:therapy*; D014944:World Health Organization
D000904:Antibiotics, Antitubercular; D012293:Rifampin