Diagnosing Drug-Resistant Tuberculosis with the Xpert<sup>®</sup>MTB/RIF. The Risk for Rifampin Susceptible Cases

• 作者: Brenda Zaragoza Rafael Laniado-Laborín
• 来源期刊: 结核病研究(英文)
• 学科: 医学
• 关键词: Diagnosis Tuberculosis ISONIAZID Failure RELAPSE
• 年，卷（期）: 2017,（3）
• 页码范围: 155-160
• 页数: 6页
• 分类号: R73

摘要

Setting: Tuberculosis clinic in México. Objective: Since the Xpert®MTB/RIF does not detect resistance to isoniazid, our objective was to emphasize the need for additional drug susceptibility testing. Design: A prospective study. All patients with an Xpert®MTB/RIF and a positive tuberculosis culture with drug susceptibility testing were included. Results: 70 patients were included. Forty-two (60%) had a history of previous treatment for TB. Fourteen patients (20%) had a strain resistant to isoniazid (H), twelve of them (85.7%) with a history of TB treatment in the past vs. 2 (7.1%) among new cases (p = 0.028). Four patients (5.7%) had resistance to rifampin (R);three of them were previously treated cases. Additionally, six patients with a negative Xpert test (8.6%) had a positive MGIT culture;three of them were resistant to H (the 3 were poly-resistant). Two patients with a positive Xpert®MTB/RIF test without R resistance were phenotypically multidrug-resistant. Conclusion: Isoniazid resistance is associated with overall increased treatment failure, relapse, and acquired multidrug resistance in patients treated with regimens containing only first-line tuberculosis drugs. It is urgent that national TB programs implement the necessary infrastructure to complement the Xpert®MTB/RIF results with DST either by phenotypic or genotypic methods.