title: Molecular drug susceptibility testing in the Netherlands: performance of the MTBDRplus and MTBDRsl assays.
abstract: BACKGROUND
  The performance of molecular drug susceptibility testing in countries with a low prevalence of drug resistance, such as the Netherlands, has not been adequately studied.
  
  
  OBJECTIVE
  To evaluate the diagnostic accuracy of the GenoType(®) MTBDRplus and MTBDRsl assays to detect resistance to first- and second-line anti-tuberculosis drugs in the context of a nationwide screening programme in the Netherlands.
  
  
  RESULTS
  The MTBDRplus assay had a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 100%, 99%, 80% and 100% for detecting rifampicin resistance. The sensitivity, specificity, PPV and NPV of either a katG or inhA mutation for detecting isoniazid resistance were 88%, 100%, 100% and 99%. The MTBDRsl assay had a sensitivity, specificity, PPV and NPV of 100%, 99%, 83%, and 100% for detecting moxifloxacin resistance; 62%, 71%, 58% and 74%, respectively, for detecting ethambutol resistance; 86%, 99%, 86% and 99% for detecting amikacin resistance; and 50%, 96%, 71% and 91% for detecting capreomycin resistance.
  
  
  CONCLUSIONS
  The MTBDRplus and MTBDRsl assays may aid in decision making in tuberculosis treatment in low-level drug resistance settings and should preferably be used to exclude resistance.
authors.affiliation: Department of Respiratory Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: S O
authors.initials: SO
authors.lastname: Simons
authors.affiliation: National Tuberculosis Reference Laboratory, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
authors.forename: T
authors.initials: T
authors.lastname: van der Laan
authors.affiliation: National Tuberculosis Reference Laboratory, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: de Zwaan
authors.affiliation: National Tuberculosis Reference Laboratory, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Kamst
authors.affiliation: Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: van Ingen
authors.affiliation: Department of Respiratory Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: P N R
authors.initials: PN
authors.lastname: Dekhuijzen
authors.affiliation: Department of Respiratory Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: M J
authors.initials: MJ
authors.lastname: Boeree
authors.affiliation: Department of Respiratory Medicine, Radboud University Medical Center, Nijmegen, The Netherlands; National Tuberculosis Reference Laboratory, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands; Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: D
authors.initials: D
authors.lastname: van Soolingen
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000145:classification* / Q000627:therapeutic use*; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics*; D054908:Extensively Drug-Resistant Tuberculosis / Q000188:drug therapy* / Q000235:genetics*; D005260:Female; D005838:Genotype; D006801:Humans; D016015:Logistic Models; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D015999:Multivariate Analysis; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D009426:Netherlands; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents