ArticleJournal of clinical microbiology2026
Xpert MTB/XDR performance in non-sputum samples for diagnosis of drug-resistant tuberculosis at a North Indian tertiary care center.
Article in Journal of clinical microbiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Rapid diagnosis of drug-resistant tuberculosis (DR-TB) is very challenging, specifically in extra-pulmonary TB specimens. The current study was performed on non-sputum specimens. All specimens were subjected on Xpert MTB/RIF Ultra followed by Xpert MTB/XDR, Ziehl-Neelsen (ZN) Staining, liquid culture, line probe assay (LPA), and drug susceptibility testing (DST). Out of 1,152 non-sputum specimens, 218 were observed to be positive on Xpert MTB/RIF Ultra and were selected for further investigation. From 218 MTBC positive, Xpert MTB/XDR yielded 174 (79.8%) positive while 25 (11.5%) were negative. On comparison with reference standards, ZN smear, and culture, the sensitivity was 100% and 95.51% with specificity of 17.86% and 18.63%, respectively. DST sensitivity and specificity were 84.62% and 96.61%, 83.33% and 96.88%, 50% and 98.75%, 50% and 98.72%, and 50% and 98.75%, respectively, for isoniazid, fluoroquinolones, amikacin, kanamycin, and capreomycin in culture positive specimens. The sensitivity and specificity of Xpert MTB/XDR assay, compared with LPA (MTBDR IMPORTANCE: This study provides crucial evidence supporting the use of Xpert MTB/XDR for rapid detection of DR-TB in non-sputum specimens including extra-pulmonary specimens, where diagnosis remains challenging due to paucibacillary in nature. By demonstrating high sensitivity and specificity compared with culture-DST and LPA, the assay shows strong potential to be integrated into the National TB Elimination Program (NTEP) diagnostic algorithm. Early detection of resistance to isoniazid, fluoroquinolones, and second-line injectables enables timely transition to DST-guided treatment, reducing delays and improving patient outcomes. The findings highlight the assay's ability to reduce dependency on conventional laboratory-based DST, shortening turnaround time and strengthening decentralized diagnostic capacity. This study provides programmatic evidence for policy-level adoption, supporting India's efforts toward DR-TB control and elimination.
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