Validation of the GenoType MTBDRplus assay for diagnosis of multidrug resistant tuberculosis in South Vietnam

Abstract

Background: To control multidrug resistant tuberculosis (MDR-TB), the drug susceptibility profile is needed to guide therapy. Classical drug susceptibility testing (DST) may take up to 2 to 4 months. The GenoType MTBDRplus test is a commercially available line-probe assay that rapidly detects Mycobacterium tuberculosis (MTB) complex, as well as the most common mutations associated with rifampin and isoniazid resistance.We assessed sensitivity and specificity of the assay by using a geographically representative set of MTB isolates from the South of Vietnam.

Methods: We re-cultured 111 MTB isolates that were MDR, rifampin-resistant or pan-susceptible according to conventional DST and tested these with the GenoType MTBDRplus test.

Results: By conventional DST, 55 strains were classified as MDR-TB, four strains were rifampicin mono-resistant and 52 strains were susceptible to all first-line drugs. The sensitivity of the GenoType MTBDRplus was 93.1% for rifampicin, 92.6% for isoniazid and 88.9% for the combination of both; its specificity was 100%. The positive predictive value of the GenoType MTBDRplus test for MDR-TB was 100% and the negative predictive value 90.3%.

Conclusions: We found a high specificity and positive predictive value of the GenoType MTBDRplus test for MDR-TB which merits its use in the MDR-TB treatment program in Vietnam.

Figure 1

Patterns of multiple Mycobacterium spp. infections as obtained by RFLP and spoligotyping techniques. The first three isolates have only one band by RFLP (non-Beijing) and spoligotype T1; the 4^th sample is a mixture of Beijing genotype (as obtained by RFLP) and spoligotype T1. The 5^th sample has no RFLP banding pattern and an undefined spoligotype, whereas for the last three isolates no banding patterns were found by RFLP and spoligotyping, probably as a result of the presence of non-tuberculous mycobacteria (NTM).