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Meta-Analysis
. 2019 Aug 22;14(8):e0221427.
doi: 10.1371/journal.pone.0221427. eCollection 2019.

Diagnostic accuracy of the Xpert MTB/RIF assay for bone and joint tuberculosis: A meta-analysis

Yanqin Shen  1 , Guocan Yu  1 , Fangming Zhong  1 , Xiaohua Kong  1
Affiliations
Meta-Analysis

Diagnostic accuracy of the Xpert MTB/RIF assay for bone and joint tuberculosis: A meta-analysis

Yanqin Shen et al. PLoS One. .

Abstract

Background: This study aimed to evaluate the accuracy of the Xpert MTB/RIF assay for the diagnosis of bone and joint tuberculosis.

Methods: We searched databases from their inception to May 7, 2019 for published articles and reviewed them to assess the accuracy of Xpert MTB/RIF with respect to a composite reference standard (CRS) and mycobacterial culture. Meta-analyses were performed using a bivariate random-effects model, and the sources of heterogeneity were assessed via subgroup analysis and meta-regression.

Results: Nineteen independent (9 prospective, 5 retrospective, and 5 case-control) studies that compared Xpert MTB/RIF with the CRS and 14 (6 prospective, 7 retrospective, and 1 case-control) studies that compared it with culture were included. The pooled sensitivity and specificity of Xpert MTB/RIF were 81% (95% confidence interval [CI], 77-84) and 99% (95% CI, 97-100) compared to the CRS, respectively, and 96% (95% CI, 90-98) and 85% (95% CI, 57-96) compared to culture, respectively. The pooled sensitivity and specificity using pus samples vs. the CRS were 82% (95% CI, 76-86) and 99% (95% CI, 95-100), respectively. The proportions obtained while working with tissue samples vs. the CRS were 84% (95% CI, 76-90) and 98% (95% CI, 94-99), respectively. There was no significant difference in diagnostic accuracy among the types of specimens.

Conclusions: Xpert MTB/RIF demonstrates good diagnostic accuracy for bone and joint tuberculosis, the results of which are not related to the type of specimen.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Literature retrieval flow chart.
124, 22, 228, 15, 11 articles were found from Pubmed, the Cochrane Library, Embase, Wanfang database and CNKI respectively.
Fig 2
Fig 2. Methodological quality graphs (risk of bias and applicability concerns) as percentages across the included studies.
a: composite reference standard. b: culture reference standard.
Fig 3
Fig 3. Forest plot of Xpert sensitivity and specificity for tuberculosis detection in BJTB compared with a composite reference standard.
BJTB: bone and joint tuberculosis.
Fig 4
Fig 4. Forest plot of Xpert sensitivity and specificity for tuberculosis detection in BJTB compared with culture reference standard.
BJTB: bone and joint tuberculosis.
Fig 5
Fig 5. Forest plot of Xpert sensitivity and specificity for tuberculosis detection in BJTB vs. composite reference standard.
a: pus samples. b: tissue samples. BJTB: Bone and joint tuberculosis.
Fig 6
Fig 6. Forest plot of Xpert sensitivity and specificity for tuberculosis detection in BJTB for spinal tuberculosis.
a: composite reference standard. b: culture reference standard. BJTB: Bone and joint tuberculosis.
See this image and copyright information in PMC

References

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