ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2025
Paucibacillary Tuberculosis Drives the Low Positive Predictive Value of Xpert MTB/RIF Ultra for Rifampicin Resistance Detection in Low-Prevalence Settings.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed.
- Article
- Key operational challenges at a programmatic level to achieve optimal use of the GeneXpert platform.IJTLD open · 2026Article
- A two-step hybridization-capture aptasensor with dithiol-DNA-AuNPs interface for rapid, label-free detection of Mycobacterium tuberculosis H37Rv.Analytical and bioanalytical chemistry · 2026Article
- Evaluation of Xpert MTB/RIF assay accuracy for diagnosing TB and detecting rifampin resistance in patients with very low bacterial loads results: a retrospective study in Hunan, China.BMC infectious diseases · 2026Article
- Rapid Molecular Diagnostics of Tuberculosis: What Do We Have, What Do We Need?Pulmonary medicine · 2026Review
- Concordance between initial GeneXpert MTB/RIF results and follow-up diagnostic testing in patients treated for multidrug-resistant tuberculosis in Lusaka, Zambia.The Pan African medical journal · 2025Article
- Diversity, Distribution, and Resistance Profiles of Bacterial Bloodstream Infections in Three Tertiary Referral Hospitals in Rwanda Between 2020 and 2022.Antibiotics (Basel, Switzerland) · 2024Article
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16 authors.
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Abstract
backgroundXpert MTB/RIF Ultra (Ultra) aimed to improve the specificity in identifying rifampicin-resistant tuberculosis (RR-TB), compared to Xpert MTB/RIF.
methodsIn a nationwide study in Rwanda, patients diagnosed with RR-TB by Ultra between December 2021 and January 2024 underwent repeat Ultra testing, complemented by rpoB gene sequencing and phenotypic drug-susceptibility testing (pDST), serving as reference tests.
resultsOf 129 patients initially diagnosed with RR-TB by Ultra, only 41 (32%) had concordant rifampicin results upon repeat Ultra testing. The remaining 88 patients (68%) had unconfirmed resistance on repeat Ultra. Reference testing was available for 40 (98%) of 41 confirmed cases, all verified as true RR-TB. Among 88 unconfirmed cases, reference testing was available for 61 (69%), with 7 (11%) confirmed as true RR-TB, whereas 54 (89%) were found to have rifampicin-susceptible TB. Notably, 89% of 55 patients with very low bacillary loads on their initial Ultra had false RR-TB results, a significantly higher risk of false resistance compared to other bacillary load categories combined (risk ratio: 8.20; 95% confidence interval [CI]: 3.56-18.85; P < .001). Consequently, 53% (54/101) of initial RR patients with available reference testing received unnecessary RR-TB treatment.
conclusionsUltra represents a valuable tool for rapid RR-TB detection; however, in low prevalence settings its low positive predictive value for RR detection is largely driven by samples with very low bacillary loads. As programs expand active case-finding and early detection of asymptomatic disease, the proportion of TB detected with very low bacillary load will increase. Diagnostic algorithms require adjustments to prevent unnecessary RR-TB treatment.
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