Retrospective Cohort Analysis for Identification of Discordant Rifampicin-resistant Xpert MTB/RIF Assay Results in South Kivu, Eastern Democratic Republic of the Congo, a High Burden Tuberculosis Setting.
Background The Xpert assay has revolutionized the rapid detection of resistance to rifampicin. However, Xpert has its pitfalls. We explored potential determinants of false-positive rifampicin resistance when using Xpert, aiming to refine the precision of tuberculosis diagnostics and subsequently con...
| Publicado en: | Clinical Infectious Diseases Vol. 82; no. 2; pp. 274 - 282 |
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| Autores principales: | , , , , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Oxford University Press / USA
2/15/2026
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=191893966&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 191893966 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 10584838 46X jtl: Clinical Infectious Diseases issn: 10584838 maglogo: N pubinfo: dt: 2/15/2026 vid: 82 iid: 2 pid: 622 pub: Oxford University Press / USA artinfo: ui: 191893966 191893966 191893966 10.1093/cid/ciaf451 191893966 ppf: 274 ppct: 8 formats: tig: atl: Retrospective Cohort Analysis for Identification of Discordant Rifampicin-resistant Xpert MTB/RIF Assay Results in South Kivu, Eastern Democratic Republic of the Congo, a High Burden Tuberculosis Setting. aug: au: Bisimwa, Bertin C Kiselinova, Maja Cuella-Martin, Isabel Rigouts, Leen Bulabula, André N H Byela, Valéry Chirambiza, Jean-Paul Mulume, Eric Birembano, Freddy Katoto, Patrick D M C affil: Center for Tropical Diseases and Global Health, Faculty of Medicine, Catholic University of Bukavu, Bukavu, Democratic Republic of the CongoInstitut Supérieur des Techniques Médicales de Bukavu, Bukavu, Democratic Republic of the CongoMycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, BelgiumFaculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium sug: subj: Tuberculosis, Multidrug-Resistant Diagnosis Mycobacterium Tuberculosis Rifampin Drug Resistance, Microbial Molecular Diagnostic Techniques Methods Sensitivity and Specificity Human Male Female Adolescence Adult Middle Age Democratic Republic of the Congo Retrospective Design Record Review Prospective Studies Cross Sectional Studies Comparative Studies Descriptive Statistics Data Analysis Software Pearson's Correlation Coefficient Chi Square Test T-Tests Microscopy Logistic Regression Nucleic Acids Implementation Science Polymerase Chain Reaction DNA Genetics In Situ Hybridization, Fluorescence Funding Source Adolescent: 13-18 years Adult: 19-44 years Middle Aged: 45-64 years Male Female ab: Background The Xpert assay has revolutionized the rapid detection of resistance to rifampicin. However, Xpert has its pitfalls. We explored potential determinants of false-positive rifampicin resistance when using Xpert, aiming to refine the precision of tuberculosis diagnostics and subsequently contribute to better patient outcomes. Methods This is a retrospective cross-sectional analysis of archived Xpert files from the South Kivu province, used to diagnose Mycobacterium tuberculosis (MTB) between 2013 and 2018. Xpert cycle threshold was extracted for each molecular beacon probe, and Δ Ct was calculated. We used the MTBDR plus line-probe assay, which covers the same 81-bp RRDR, as a reference test. Results Of 1900 samples positive for MTB, 220 (11.2%) were rifampicin resistant. Of the 141 patients' sputum samples that had results for both Xpert and MTBDR plus , 45 (31.9%) showed discordant results with Xpert, indicating rifampicin resistance while MTBDR plus indicated rifampicin susceptibility, suggesting false-positive rifampicin resistance detection by Xpert, predominantly in samples with very low (Ct > 28, odds ratio [OR] = 2.23, 95% CI: 1.30–3.82) or low (Ct 22–28, OR = 1.81, 95% CI: 1.21–2.71) bacterial loads. Probe E was the most frequently missed probe, followed by multiple probe dropouts or absence of probe binding (OR = 1.5, 95% CI:.731–3.076). Conclusions Our findings indicate that low and very low MTB bacterial loads in sputum are strongly associated with discordant rifampicin resistance results when using Xpert. Further research into underlying mechanisms is needed to establish causality definitively. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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