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Meta-Analysis
. 2013;8(2):e55292.
doi: 10.1371/journal.pone.0055292. Epub 2013 Feb 1.

Rapid diagnosis of drug resistance to fluoroquinolones, amikacin, capreomycin, kanamycin and ethambutol using genotype MTBDRsl assay: a meta-analysis

Yan Feng  1 , Sijun Liu, Qungang Wang, Liang Wang, Shaowen Tang, Jianming Wang, Wei Lu
Affiliations
Meta-Analysis

Rapid diagnosis of drug resistance to fluoroquinolones, amikacin, capreomycin, kanamycin and ethambutol using genotype MTBDRsl assay: a meta-analysis

Yan Feng et al. PLoS One. 2013.

Abstract

Background: There are urgent needs for rapid and accurate drug susceptibility testing of M. tuberculosis. GenoType MTBDRsl is a new molecular kit designed for rapid identification of the resistance to the second-line antituberculosis drugs with a single strip. In recent years, it has been evaluated in many settings, but with varied results. The aim of this meta-analysis was to synthesize the latest data on the diagnostic accuracy of GenoType MTBDRsl in detecting drug resistance to fluoroquinolones, amikacin, capreomycin, kanamycin and ethambutol, in comparison with the phenotypic drug susceptibility test.

Methods: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. The search terms of "MTBDRsl" and "tuberculosis" were used on PubMed, EMBASE, and Web of Science. QUADAS-2 was used to assess the quality of included studies. Data were analyzed by Meta-Disc 1.4. We calculated the sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and corresponding 95% confidence interval (CI) for each study. From these calculations, forest plots and summary receiver operating characteristic (SROC) curves were produced.

Results: Patient selection bias as well as flow and timing bias were observed in most studies. The summarized sensitivity (95% CI) was 0.874(0.845-0.899), 0.826(0.777-0.869), 0.820(0.772-0.862), 0.444(0.396-0.492), and 0.679(0.652-0.706) for fluoroquinolones, amikacin, capreomycin, kanamycin, and ethambutol, respectively. The specificity (95% CI) was 0.971(0.961-0.980), 0.995(0.987-0.998), 0.973(0.963-0.981), 0.993(0.985-0.997), and 0.799(0.773-0.823), respectively. The AUC (standard error) were 0.9754(0.0203), 0.9300(0.0598), 0.9885(0.0038), 0.9689(0.0359), and 0.6846(0.0550), respectively.

Conclusion: Genotype MTBDRsl showed good accuracy for detecting drug resistance to fluoroquinolones, amikacin and capreomycin, but it may not be an appropriate choice for kanamycin and ethambutol. The lack of data did not allow for proper evaluation of the test on clinical specimens. Further systematic assessment of diagnostic performance should be carried out on direct clinical samples.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Flow chart of the meta analysis.
Figure 2
Figure 2. Forest plot of sensitivity for drug resistance to fluoroquinolones.
A. Sensitivity; B. Specificity.
Figure 3
Figure 3. Forest plot of sensitivity for drug resistance to amikacin.
A. Sensitivity; B. Specificity.
Figure 4
Figure 4. Forest plot of sensitivity for drug resistance to capreomycin.
A. Sensitivity; B. Specificity.
Figure 5
Figure 5. Forest plot of sensitivity for drug resistance to kanamycin.
A. Sensitivity; B. Specificity.
Figure 6
Figure 6. Forest plot of sensitivity for drug resistance to ethambutol.
A. Sensitivity; B. Specificity.
Figure 7
Figure 7. Summary receiver operating characteristic (SROC) curve for drug resistance to fluoroquinolones, amikacin, capreomycin, kanamycin, and ethambutol.
A. Summary receiver operating characteristic (SROC) curve for drug resistance to fluoroquinolones B Summary receiver operating characteristic (SROC) curve for drug resistance to amikacin C. Summary receiver operating characteristic (SROC) curve for drug resistance to capreomycin D. Summary receiver operating characteristic (SROC) curve for drug resistance to kanamycin E. Summary receiver operating characteristic (SROC) curve for drug resistance to ethambutol.
See this image and copyright information in PMC

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