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dc.contributor.authorArdizzoni, E
dc.contributor.authorAriza, E
dc.contributor.authorMulengwa, D
dc.contributor.authorMpala, Q
dc.contributor.authorde la Tour, R
dc.contributor.authorMaphalala, G
dc.contributor.authorVaraine, F
dc.contributor.authorKerschberger, B
dc.contributor.authorGraulus, P
dc.contributor.authorPage, A L
dc.contributor.authorNieman, S
dc.contributor.authorDreyer, V
dc.contributor.authorVan Deun, A
dc.contributor.authorDecroo, T
dc.contributor.authorRigouts, L
dc.contributor.authorde Jong, B C
dc.date.accessioned2021-04-22T18:02:01Z
dc.date.available2021-04-22T18:02:01Z
dc.date.issued2021-03-15
dc.date.submitted2021-04-17
dc.identifier.pmid33722892
dc.identifier.doi10.1128/AAC.02263-20
dc.identifier.urihttp://hdl.handle.net/10144/619937
dc.description.abstractBACKGROUND: Xpert®MTB/RIF rapidly detects resistance to rifampicin (RR), however this test misses the I491F-RR conferring rpoB mutation, common in Southern Africa. In addition, Xpert®MTB/RIF does not distinguish between viable and dead Mycobacterium tuberculosis (MTB). OBJECTIVE: To investigate the ability of thin layer agar (TLA) direct drug-susceptibility testing (DST) to detect MTB and its drug-resistance profiles in field conditions in Eswatini. DESIGN: Consecutive samples were tested in parallel with Xpert®MTB/RIF and TLA for rifampicin (1.0 μg/ml) and ofloxacin (2.0 μg/ml). TLA results were compared at the Reference Laboratory in Antwerp with indirect DST on Löwenstein-Jensen or 7H11 solid media and additional phenotypic and genotypic testing to resolve discordance. RESULTS: TLA showed a positivity rate for MTB detection of 7.1% versus 10.0% for Xpert®MTB/RIF. Of a total of 4547 samples included in the study, 200 isolates were available for comparison to the composite reference. Within a median of 18.4 days, TLA detected RR with 93.0% sensitivity (CI-77.4-98.0) and 99.4% specificity (CI 96.7-99.9), versus 62.5% (CI 42.7-78.8) and 99.3% (CI 96.2-99.9) for Xpert®MTB/RIF. Eight isolates, 28.6% of all RR confirmed isolates, carried the I491F mutation, all detected by TLA. TLA also correctly identified 183 of the 184 ofloxacin-S isolates (99.5% specificity, CI 97.0-99.9). CONCLUSIONS: In field conditions, TLA rapidly detects RR, and in this specific setting contributed to detection of additional RR patients over Xpert®MTB/RIF, mainly but not exclusively due to I491F. TLA also accurately excluded fluoroquinolones resistance.en_US
dc.language.isoenen_US
dc.publisherAmerican Society for Microbiologyen_US
dc.titleThin layer agar-based direct phenotypic drug-susceptibility testing on sputum in Eswatini rapidly detects growth and rifampicin resistance, otherwise missed by WHO endorsed diagnostic tests.en_US
dc.typeArticle
dc.identifier.eissn1098-6596
dc.identifier.journalAntimicrobial agents and chemotherapyen_US
dc.source.journaltitleAntimicrobial agents and chemotherapy
refterms.dateFOA2021-04-22T18:02:02Z
dc.source.countryUnited States


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