Performance of GenoType MTBDRsl assay for detection of second-line drugs and ethambutol resistance directly from sputum specimens of MDR-TB patients in Bangladesh

• Published in: PloS one Vol. 16; no. 12; p. e0261329
• Main Authors: Rahman, S M Mazidur, Nasrin, Rumana, Rahman, Arfatur, Ahmed, Shahriar, Khatun, Razia, Uddin, Mohammad Khaja Mafij, Rahman, Md Mojibur, Banu, Sayera
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 16-12-2021; Public Library of Science (PLoS)
• Subjects: Adult; Aged; Aged, 80 and over; Antitubercular Agents - therapeutic use; Assaying; Bangladesh - epidemiology; Biology and Life Sciences; Care and treatment; COVID-19; Diagnosis; Diagnostic systems; Disease transmission; DNA topoisomerase; DNA, Bacterial - genetics; Drug resistance; Drug resistance in microorganisms; Ethambutol; Ethambutol - therapeutic use; Extensively Drug-Resistant Tuberculosis - diagnosis; Extensively Drug-Resistant Tuberculosis - drug therapy; Extensively Drug-Resistant Tuberculosis - genetics; Female; Genotype; Genotype & phenotype; Genotypes; Genotyping Techniques - methods; Humans; Infectious diseases; Kanamycin; Kanamycin - therapeutic use; Male; Medicine and Health Sciences; Microbial Sensitivity Tests; Middle Aged; Multidrug resistance; Multidrug resistant organisms; Mutation; Mycobacterium tuberculosis - genetics; Ofloxacin; Ofloxacin - therapeutic use; Patients; People and Places; Performance evaluation; Quality control; Research and Analysis Methods; Risk factors; Rrs gene; Sensitivity; Sensitivity and Specificity; Sputum; Sputum - chemistry; Testing; Tuberculosis; Tuberculosis, Multidrug-Resistant - diagnosis; Tuberculosis, Multidrug-Resistant - drug therapy; Tuberculosis, Multidrug-Resistant - genetics; Bangladesh; Germany
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0261329

Rapid and early detection of drug susceptibility among multidrug-resistant tuberculosis (MDR-TB) patients could guide the timely initiation of effective treatment and reduce transmission of drug-resistant TB. In the current study, we evaluated the diagnostic performance of GenoType MTBDRsl (MTBDRsl) ver1.0 assay for detection of resistance to ofloxacin (OFL), kanamycin (KAN) and ethambutol (EMB), and additionally the XDR-TB among MDR-TB patients in Bangladesh.
The MTBDRsl assay was performed directly on 218 smear-positive sputum specimens collected from MDR-TB patients and the results were compared with the phenotypic drug susceptibility testing (DST) performed on solid Lowenstein-Jensen (L-J) media. We also analyzed the mutation patterns of gyrA, rrs, and embB genes for detection of resistance to OFL, KAN and EMB, respectively.
The sensitivity and specificity of the MTBDRsl compared to phenotypic L-J DST were 81.8% (95% CI, 69.1-90.9) and 98.8% (95% CI, 95.6-99.8), respectively for OFL (PPV: 95.7% & NPV: 94.1%); 65.1% (95% CI, 57.5-72.2) and 86.7% (95% CI, 73.2-94.9), respectively for EMB (PPV: 94.9% & NPV: 39.4%); and 100% for KAN. The diagnostic accuracy of KAN, OFL and EMB were 100, 94.5 and 69.6%, respectively. Moreover, the sensitivity, specificity and diagnostic accuracy of MtBDRsl for detection of XDR-TB was 100%. The most frequently observed mutations were at codon D94G (46.8%) of gyrA gene, A1401G (83.3%) of rrs gene, and M306V (41.5%) of the embB gene.
Considering the excellent performance in this study we suggest that MTBDRsl assay can be used as an initial rapid test for detection of KAN and OFL susceptibility, as well as XDR-TB directly from smear-positive sputum specimens of MDR-TB patients in Bangladesh.