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Demonstrating a Multi-drug Resistant Mycobacterium tuberculosis Amplification Microarray
Published on: April 25, 2014
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Implementation of new tools for multidrug-resistant tuberculosis detection and control
1SA MRC Centre for Tuberculosis Research, DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, Division of Molecular Biology and Human Genetics, Stellenbosch University, P.O. Box 241, Cape Town 8000, South Africa.
International Journal of Mycobacteriology
|January 4, 2017
Summary
Drug-resistant tuberculosis (TB) is driven by transmission. New molecular diagnostics like Xpert MTB/RIF rapidly detect resistance, but treatment initiation delays persist, impacting patient outcomes.
Area of Science:
- Microbiology
- Epidemiology
- Public Health
Background:
- The global drug-resistant tuberculosis (TB) epidemic is primarily driven by transmission, not just classical factors.
- Resistance amplification during treatment, potentially due to inadequate drug dosages, is an emerging concern.
- Current culture-based drug-susceptibility testing (DST) causes significant diagnostic delays, hindering timely treatment.
Purpose of the Study:
- To review the impact of molecular diagnostic tests on reducing diagnostic delays for drug-resistant TB.
- To assess the effectiveness of new diagnostic strategies in accelerating multidrug-resistant TB (MDR-TB) treatment initiation.
- To explore the role of emerging molecular assays in managing complex drug resistance patterns.
Main Methods:
- Review of molecular diagnostic tests endorsed by the World Health Organization (WHO) for TB.
- Analysis of reported turnaround times for MTBDRplus and Xpert MTB/RIF assays.
- Evaluation of treatment initiation timelines following molecular DST results.
Main Results:
- Molecular tests significantly reduced laboratory turnaround time: MTBDRplus from 55 to 27 days, Xpert MTB/RIF to 1 day.
- Despite rapid diagnostics, time to MDR-TB treatment initiation remained around 17 days post-DST results.
- Initiating MDR-TB treatment based solely on rifampicin resistance (within 5 days) is a strategy with potential benefits and risks.
Conclusions:
- Rapid molecular diagnostics are crucial for controlling drug-resistant TB transmission.
- Reducing the delay between diagnosis and treatment initiation remains a critical challenge.
- The MTBDRsl assay and shortened MDR-TB regimens require further evaluation for their impact on treatment outcomes.
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