Evidence map›Paper›PMID 24622091›Full record

ArticleJournal of clinical microbiology2014

Diagnostic accuracy of Xpert MTB/RIF for extrapulmonary tuberculosis specimens: establishing a laboratory testing algorithm for South Africa.

Lesley Erica Scott, Natalie Beylis, Mark Nicol, Gloria Nkuna, Sebaka Molapo, Leigh Berrie, Adriano Duse, Wendy Susan Stevens

Open access · bronzeAbstract readEvaluation Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of clinical microbiology, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 57 papers, 12 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
57citing papers in PubMed, 12 pooled it
5.8field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

57 citing papers in PubMed, 12 syntheses or guidelines pooled it, 113 citations in OpenAlex.

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  10. XpertThe Cochrane database of systematic reviews · 2018
    Pooled it
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  13. Article
  14. Article
  15. Article
  16. Article
  17. More Than a Decade of GeneXpertDiagnostics (Basel, Switzerland) · 2023
    Article
  18. An Analysis of Xpert Test for Diagnosing Maxillofacial Tuberculosis.Journal of maxillofacial and oral surgery · 2023
    Article
  19. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 2 institutions in 1 country.

Lesley Erica ScottDepartment of Molecular Medicine and Haematology, School of Pathology, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa lesley.scott@nhls.ac.za.
Natalie BeylisNational Health Laboratory Service, South Africa Division of Clinical Microbiology and Infectious Diseases; University of the Witwatersrand, Johannesburg, South Africa.
Mark NicolDivision of Medical Microbiology, Department of Clinical Laboratory Sciences and Institute for Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa National Health Laboratory Service, South Africa.
Gloria NkunaDepartment of Molecular Medicine and Haematology, School of Pathology, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa.
Sebaka MolapoNational Health Laboratory Service, National Priority Program, Johannesburg, South Africa.
Leigh BerrieNational Health Laboratory Service, National Priority Program, Johannesburg, South Africa.
Adriano DuseNational Health Laboratory Service, South Africa Division of Clinical Microbiology and Infectious Diseases; University of the Witwatersrand, Johannesburg, South Africa.
Wendy Susan StevensDepartment of Molecular Medicine and Haematology, School of Pathology, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa National Health Laboratory Service, National Priority Program, Johannesburg, South Africa.
National Health Laboratory Service · ZAUniversity of the Witwatersrand · ZA

Funding

PS08-868, S. Africa: EXPANSION OF HIV/AIDS, STD AND TB LABORATORY ACTIVITIES AT THE NATIONAL INSTITUTEU2GPS001328 · PS · NATIONAL HEALTH LABORATORY SERVICE · PI VAN HEERDEN, DR. JOHAN · 2008 to 2012
$44.4M
NCHHSTP CDC HHS U2G PS001328PEPFARPHS HHS 3U2GPS0001328-04
6 · The paper itself

Abstract

South Africa implemented Xpert MTB/RIF as the initial diagnostic test for pulmonary tuberculosis (TB). Xpert MTB/RIF's accuracy for diagnosing extrapulmonary tuberculosis (EPTB) was investigated. EPTB specimens (n = 7,916) from hospitalized patients received over a 6-month period at a high-throughput TB referral laboratory in Johannesburg were investigated. Large-volume specimens were centrifuged, tissue biopsy specimens homogenized, and all specimens checked for growth of contaminating bacteria on blood agar. Contaminated samples received NALC-NaOH (N-acetyl-l-cysteine-sodium hydroxide) decontamination prior to liquid culture. Residual specimens (volumes > 1 ml) after inoculation of culture (n = 1,175) were tested using the Xpert MTB/RIF sputum protocol. Using culture as the reference, Xpert MTB/RIF's overall sensitivity was 59% (95% confidence interval [95% CI], 53% to 65%) and specificity was 92% (CI, 90% to 94%), with the highest sensitivities of 91% (95% CI, 78% to 97%) for pus, 80% (95% CI, 56% to 94%) for lymph node aspirates, and 51% (95% CI, 44% to 58%) for fluids (ascitic, 59%; pleural, 47%). A difference in sensitivities was noticed between specimens classified as having a thick (87% [95% CI, 76% to 94%]) versus clear (watery) (48% [95% CI, 36% to 61%]) appearance. This was unchanged with traces of blood (52% [95% CI, 44% to 60%]) or precentrifugation (57% [95% CI, 28% to 82%]) among clear specimens. Xpert MTB/RIF generated an additional 124 specimen results that were contaminated by Mycobacterial Growth Indicator Tubes (MGIT; 10.5%) and diagnosed rifampin (RIF) resistance earlier (9.6% [25/260]). Xpert MTB/RIF's performance on EPTB specimens provides very promising results and should be considered for incorporation into national TB guidelines. Xpert MTB/RIF is less affected by contaminating bacteria and reduces laboratory labor and diagnostic delay compared to traditional methods.

Indexed as

AlgorithmsAdolescentAdultAgedAged, 80 and overAntitubercular AgentsBacteriological TechniquesBody FluidsChildChild, PreschoolDrug Resistance, BacterialFemaleHumansInfantInfant, NewbornLymph NodesAntitubercular AgentsRifampin

Identifiers

PMID24622091
PMCPMC4042800
OpenAlexW2105277316

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.