SCI 발표논문

SCI 발표논문

← SCI 발표논문 목록

PLoS One. 2016;11(10):e0164923.

Discordance between MTB/RIF and Real-Time Tuberculosis-Specific Polymerase Chain Reaction Assay in Bronchial Washing Specimen and Its Clinical Implications.

, , , , ,

제1저자 조용숙 · 교신저자 김덕겸

소속 (2)
  1. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
  2. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea.

Abstract

The prevalence and clinical implications of discordance between Xpert MTB/RIF assays and the AdvanSure TB/NTM real-time polymerase chain reaction (PCR) for bronchial washing specimens have not been studied in pulmonary TB (PTB) patients. The discordant proportion and its clinical impact were evaluated in 320 patients from the bronchoscopy registry whose bronchial washing specimens were tested simultaneously with Xpert MTB/RIF and the TB/NTM PCR assay for three years, and the accuracy of the assays, including the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), were studied. The clinical risk factors for discordance and false positivity of assays were also studied. Among 130 patients who were clinically diagnosed with PTB, 64 patients showed positive acid-fast bacilli culture results, 56 patients showed positive results in molecular methods and clinician diagnosed PTB without results of microbiology in 10 patients. The sensitivity, specificity, PPV, and NPV were 80.0%, 98.95%, 98.1%, and 87.9%, respectively, for Xpert MTB/RIF and 81.5%, 92.6%, 88.3%, and 88.0%, respectively, for TB/NTM PCR. The discordant proportion was 16.9% and was higher in culture-negative PTB compared to culture-confirmed PTB (24.3% vs. 9.4%, p = 0.024). However, there were no significant differences in the clinical characteristics, regardless of the discordance. The diagnostic yield increased with an additional assay (7.7% for Xpert MTB/RIF and 9.2% for TB/NTM PCR). False positivity was less common in patients tested with Xpert MTB/RIF (1.05% vs. 7.37%, p = 0.0035). No host-related risk factor for false positivity was identified. The Xpert MTB/RIF and TB/NTM PCR assay in bronchial washing specimens can improve the diagnostic yields for PTB, although there were considerable discordant results without any patient-related risk factors.

Figures

Fig 1
Fig 1 Study flow. Abbreviation: AFB = acid-fast bacilli, TB = tuberculosis, PCR = polymerase chain reaction, NTM = non-tuberculosis mycobacterium. * other diseases (number): bronchiectasis(3), empyema(3), benign bronchial stenosis(2), anthracofibrosis(1), fungal ball(1), lung abscess(1), diffuse panbronchiolitis(1). ** Pulmonary TB (PTB) with growth of M. tuberculosis in culture study. † PTB without growth of M. tuberculosis which was diagnosed with PCR for TB or clinical decision.
Fig 2
Fig 2 Diagnostic probability of TB according to the application order of real time TB/NTM PCR or Xpert MTB/RIF assay in patients with culture confirmed PTB.
Fig 3
Fig 3 Diagnostic probability of TB according to the application order of real time TB/NTM PCR or Xpert MTB/RIF assay in patients with culture-negative PTB.

그림 출처: PubMed Central 공개 논문 (PMC5070776)

Conflict of interest statement

The authors have declared that no competing interests exist.

그 밖의 정보
출판 형태
Journal Article
저널
PloS one · eISSN 1932-6203
전자 출판
2016-10-19
MeSH
Aged · Aged, 80 and over · Bacteriological Techniques / methods · Bronchoalveolar Lavage · Bronchoalveolar Lavage Fluid / microbiology · Early Diagnosis · Female · Humans · Male · Middle Aged · Mycobacterium tuberculosis / genetics / growth & development · Real-Time Polymerase Chain Reaction · Sensitivity and Specificity · Sputum / microbiology · Tuberculosis, Pulmonary / diagnosis / microbiology
참고문헌
26편