RT Journal Article
SR Electronic
T1 The utility of Xpert MTB/RIF performed on bronchial lavages obtained from patients with suspected pulmonary tuberculosis
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP PA1530
DO 10.1183/13993003.congress-2015.PA1530
VO 46
IS suppl 59
A1 Coenraad Koegelenberg
A1 Dewald Barnard
A1 Johannes Bruwer
A1 Dante Plekker
A1 Andrew Whitelaw
A1 Jacobus Deetlefs
A1 Elvis Irusen
YR 2015
UL http://erj.ersjournals.com/content/46/suppl_59/PA1530.abstract
AB Background: Xpert MTB/Rif has been shown to have a superior sensitivity to microscopy for acid fast bacilli (AFB) in sputum and is recommended as a point-of-care test. Bronchoscopy is a valuable tool in diagnosing pulmonary tuberculosis (TB) in sputum negative patients. There is limited data on the utility of Xpert MTB/Rif performed on bronchial lavages.Aim: To evaluate the diagnostic efficiency of Xpert MTB/Rif performed on bronchial lavage in sputum scarce or sputum negative patients with suspected pulmonary TB.Methods: All patients with a clinical and radiological suspicion of pulmonary TB who underwent bronchoscopy between January 2013 and April 2014 were included. The diagnostic efficiency of Xpert MTB/Rif, microscopy for AFB and culture for Mycobacterium tuberculosis were evaluated.Results: 42 of 112 patients were diagnosed with confirmed pulmonary TB; 39 were culture positive and Xpert MTB/Rif was positive in 37 of 42. Xpert MTB/RIF had a sensitivity of 88.1% (95%CI; 73.6-95.5%) for TB, which was superior to that of smear microscopy (38.1%; 95%CI; 24.0-54.3, p=0.005). The specificity of Xpert MTB/Rif was comparable to smear microscopy (88.6%; 95%CI; 78.2-94.6 vs. 98.6%; 95%CI; 91.2-99.9). Xpert MTB/Rif had a positive predictive value of 82.2% (95%CI; 67.4-91.5) and negative predictive value of 92.5% (95%CI; 82.7-97.2). Eight false positive Xpert MTB/RIF cases were identified.Conclusion: Xpert MTB/RIF has a higher sensitivity than smear microscopy and similar specificity for the immediate confirmation of pulmonary TB in specimens obtained by bronchial lavage, and should be utilised in patients with a high clinical suspicion of pulmonary tuberculosis.