Utilization of Truenat chips in defining XDR, pre-XDR and MDR in tuberculous meningitis

IF 2.8 3区医学 Q3 IMMUNOLOGY Tuberculosis Pub Date : 2024-03-24 DOI:10.1016/j.tube.2024.102513

Kusum Sharma , Megha Sharma , Ritu Shree , Neeraj Singla , Himanshu Joshi , Tanish Modi , Manoj Goyal , Aman Sharma , Navneet Sharma , Manish Modi

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Abstract

Setting and objective

To develop and evaluate newer molecular tests that identify drug resistance according to contemporary definitions in Tuberculous meningitis (TBM), the most severe form of EPTB.

Design

93 cerebrospinal fluid (CSF) specimens [41 culture-positive and 52 culture-negative], were subjected to Truenat MTB Plus assay along with chips for rifampicin, isoniazid, fluoroquinolones and bedaquiline resistance. The performance was compared against phenotypic drug susceptibility testing (pDST), Line probe assay (LPA) and gene sequencing.

Results

Against pDST, Truenat chips had a sensitivity and specificity of 100%; 94.47%, 100%; 94.47%, 100%; 97.14% and 100%; 100%, respectively for rifampicin, isoniazid, fluoroquinolones and bedaquiline. Against LPA, all Truenat chips detected resistant isolates with 100% sensitivity; but 2 cases each of false-rifampicin and false-isoniazid resistance and 1 case of false-fluoroquinolone resistance was reported. Truenat drug chips gave indeterminate results in ∼25% cases, which were excluded. All cases reported indeterminate were found to be susceptible by pDST/LPA.

Conclusion

The strategic drug resistance chips of Truenat Plus assay can contribute greatly to TB elimination by providing rapid and reliable detection of drug resistance pattern in TBM. Cases reported indeterminate require confirmation by other phenotypic and genotypic methods.

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利用 Truenat 芯片确定结核性脑膜炎中的 XDR、前 XDR 和 MDR

设计93份脑脊液（CSF）标本（41份培养阳性，52份培养阴性）与利福平、异烟肼、氟喹诺酮类药物和贝达喹啉耐药性芯片一起进行了Truenat MTB Plus检测。结果与表型药敏试验（pDST）相比，Truenat芯片对利福平、异烟肼、氟喹诺酮类药物和贝达喹啉耐药性的敏感性和耐受性均优于pDST。结果与 pDST 相比，Truenat 芯片对利福平、异烟肼、氟喹诺酮类药物和贝达喹啉的敏感性和特异性分别为 100%、94.47%、100%、94.47%、100%、97.14% 和 100%、100%。对 LPA，所有 Truenat 芯片都能检测到耐药的分离物，灵敏度均为 100%；但报告了 2 例假利福平和假异烟肼耐药，以及 1 例假氟喹诺酮耐药。Truenat药物芯片有25%的病例结果不确定，这些病例被排除在外。结论 Truenat Plus 检测法的战略性耐药芯片可快速、可靠地检测结核杆菌的耐药模式，从而为消除结核病做出巨大贡献。报告的不确定病例需要通过其他表型和基因型方法进行确认。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Tuberculosis 医学-呼吸系统

CiteScore

4.60

自引率

3.10%

发文量

审稿时长

49 days

期刊介绍： Tuberculosis is a speciality journal focusing on basic experimental research on tuberculosis, notably on bacteriological, immunological and pathogenesis aspects of the disease. The journal publishes original research and reviews on the host response and immunology of tuberculosis and the molecular biology, genetics and physiology of the organism, however discourages submissions with a meta-analytical focus (for example, articles based on searches of published articles in public electronic databases, especially where there is lack of evidence of the personal involvement of authors in the generation of such material). We do not publish Clinical Case-Studies. Areas on which submissions are welcomed include: -Clinical TrialsDiagnostics- Antimicrobial resistance- Immunology- Leprosy- Microbiology, including microbial physiology- Molecular epidemiology- Non-tuberculous Mycobacteria- Pathogenesis- Pathology- Vaccine development. This Journal does not accept case-reports. The resurgence of interest in tuberculosis has accelerated the pace of relevant research and Tuberculosis has grown with it, as the only journal dedicated to experimental biomedical research in tuberculosis.