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. 2014 Mar;46(1):30-4.
doi: 10.3947/ic.2014.46.1.30. Epub 2014 Mar 21.

GeneXpert MTB/RIF Testing in the Management of Patients with Active Tuberculosis; A Real Life Experience from Saudi Arabia

Ali S Omrani  1 , Mohammed F Al-Otaibi  2 , Souad M Al-Ateah  3 , Fahad M Al-Onazi  2 , Kamran Baig  4 , Noura A El-Khizzi  3 , Ali M Albarrak  1
Affiliations

GeneXpert MTB/RIF Testing in the Management of Patients with Active Tuberculosis; A Real Life Experience from Saudi Arabia

Ali S Omrani et al. Infect Chemother. 2014 Mar.

Abstract

Background: GeneXpert MTB/RIF is a real-time PCR assay with established diagnostic performance in pulmonary and extra-pulmonary forms of tuberculosis. The aim of this study was to assess the contribution of GeneXpert MTB/RIF assay to the management of patients with any form of active tuberculosis in a single large tertiary center in Saudi Arabia, with a special focus on the impact on time to start of antituberculous therapy compared with Ziehl-Neelsen (ZN) smears and mycobacterial cultures.

Materials and methods: Clinical, radiological and laboratory records for all patients who were commenced on antituberculous therapy between March 2011 and February 2013 were retrospectively reviewed.

Results: A total of 140 patients were included, 38.6% of which had pulmonary tuberculosis. GeneXpert MTB/RIF was requested for only 39.2% of patients and was the only reason for starting antituberculous therapy for only 12.1%. The median time to a positive GeneXpert MTB/RIF result was 0 days (IQR 3) compared with 0 day (IQR 1) for smear microscopy (P > 0.999) and 22 days (IQR 21) for mycobacterial cultures (P < 0.001). No patients discontinued antituberculous therapy because of a negative GeneXpert MTB/RIF result.

Conclusions: In a setting wherein physicians are highly experienced in the diagnosis and treatment of tuberculosis, GeneXpert MTB/RIF was remarkably under-utilized and had only a limited impact on decisions related to starting or stopping antituberculous therapy. Cost-effectiveness and clinical utility of routine testing of all smear-negative clinical samples submitted for tuberculosis investigations by GeneXpert MTB/RIF warrant further study.

Keywords: GeneXpert MTB/RIF; Saudi Arabia; Tuberculosis.

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Figures

Figure 1
Figure 1
Basis for diagnosis of tuberculosis (TB) at start of anti-tuberculous therapy; number (percentage).
See this image and copyright information in PMC

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