title: High prevalence of multidrug-resistant tuberculosis among patients with rifampicin resistance using GeneXpert Mycobacterium tuberculosis/rifampicin in Ghana.
abstract: Drug-resistant strains of tuberculosis (TB) represent a major threat to global TB control. In low- and middle-income countries, resource constraints make it difficult to identify and monitor cases of resistance using drug susceptibility testing and culture. Molecular assays such as the GeneXpert Mycobacterium tuberculosis/rifampicin may prove to be a cost-effective solution to this problem in these settings. The objective of this study is to evaluate the use of GeneXpert in the diagnosis of pulmonary TB since it was introduced into two tertiary hospitals in Ghana in 2013.
  
  
  
  A 2-year retrospective audit of clinical cases involving patients who presented with clinically suspected TB or documented TB not improving on standard therapy and had samples sent for GeneXpert testing.
  
  
  
  GeneXpert identified 169 cases of TB, including 17 cases of rifampicin-resistant TB. Of the seven cases with final culture and drug susceptibility testing results, six demonstrated further drug resistance and five of these were multidrug-resistant TB.
  
  
  
  These findings call for a scale-up of TB control in Ghana and provide evidence that the expansion of GeneXpert may be an optimal means to improve case finding and guide treatment of drug-resistant TB in this setting.
authors.affiliation: Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
authors.forename: Justice K
authors.initials: JK
authors.lastname: Boakye-Appiah
authors.affiliation: Department of Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA. Electronic address: alexis.steinmetz@gmail.com.
authors.forename: Alexis R
authors.initials: AR
authors.lastname: Steinmetz
authors.affiliation: Department of Medicine, Korle Bu Teaching Hospital, Accra, Ghana.
authors.forename: Peter
authors.initials: P
authors.lastname: Pupulampu
authors.affiliation: Microbiology Laboratory, Koforidua Regional Hospital, Koforidua Central Business District, Eastern Region, Ghana.
authors.forename: Stephen
authors.initials: S
authors.lastname: Ofori-Yirenkyi
authors.affiliation: Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
authors.forename: Ishmael
authors.initials: I
authors.lastname: Tetteh
authors.affiliation: Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
authors.forename: Michael
authors.initials: M
authors.lastname: Frimpong
authors.affiliation: Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
authors.forename: Patrick
authors.initials: P
authors.lastname: Oppong
authors.affiliation: Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana; School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
authors.forename: Ohene
authors.initials: O
authors.lastname: Opare-Sem
authors.affiliation: Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana; School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
authors.forename: Betty R
authors.initials: BR
authors.lastname: Norman
authors.affiliation: Department of Internal Medicine/Infectious Diseases, University of Groningen Medical Center, Groningen, The Netherlands.
authors.forename: Ymkje
authors.initials: Y
authors.lastname: Stienstra
authors.affiliation: Department of Internal Medicine/Infectious Diseases, University of Groningen Medical Center, Groningen, The Netherlands.
authors.forename: Tjip S
authors.initials: TS
authors.lastname: van der Werf
authors.affiliation: Institute of Infection and Immunity, St. George's University of London, London, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Wansbrough-Jones
authors.affiliation: National TB Control Program, Ghana Health Service, Ministries, Accra, Ghana.
authors.forename: Frank
authors.initials: F
authors.lastname: Bonsu
authors.affiliation: Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
authors.forename: Joseph
authors.initials: J
authors.lastname: Obeng-Baah
authors.affiliation: Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana; Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
authors.forename: Richard O
authors.initials: RO
authors.lastname: Phillips
mesh_terms: D000904:Antibiotics, Antitubercular / Q000494:pharmacology*; D024881:Drug Resistance, Bacterial; D005260:Female; D005869:Ghana / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D015995:Prevalence; D012189:Retrospective Studies; D012293:Rifampin / Q000494:pharmacology*; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology*
chemical_list: D000904:Antibiotics, Antitubercular; D012293:Rifampin
keywords: GeneXpert; GeneXpert MTB/RIF; Multidrug-resistant tuberculosis; Xpert MTB/RIF