PMID- 20813587
OWN - NLM
STAT- MEDLINE
DCOM- 20101019
LR  - 20230815
IS  - 1474-4457 (Electronic)
IS  - 1473-3099 (Linking)
VI  - 10
IP  - 10
DP  - 2010 Oct
TI  - Microscopic-observation drug susceptibility and thin layer agar assays for the 
      detection of drug resistant tuberculosis: a systematic review and meta-analysis.
PG  - 688-98
LID - 10.1016/S1473-3099(10)70165-1 [doi]
AB  - BACKGROUND: Simple, rapid, and affordable tests are needed to detect drug 
      resistance in Mycobacterium tuberculosis. We did a systematic review and 
      meta-analysis to investigate the accuracy of microscopic-observation drug 
      susceptibility (MODS) and thin layer agar (TLA) assays for rapid screening of 
      patients at risk of drug-resistant tuberculosis. METHODS: In accordance with 
      protocols and methods recommended by the Cochrane Diagnostic Test Accuracy 
      Working Group, we systematically searched PubMed, Embase, and Biosis for reports 
      published between January, 1990, and February, 2009. We included studies 
      investigating detection of drug resistance in M tuberculosis with the MODS or TLA 
      assay, and in which an accepted reference standard was used. Data extracted from 
      the studies were combined by use of bivariate random-effects regression models 
      and hierarchical summary receiver operating characteristic curves to estimate 
      sensitivity and specificity for detection of resistance to specific drugs. 
      FINDINGS: We identified 12 studies, of which nine investigated the MODS assay and 
      three investigated the TLA assay. For the MODS assay of rifampicin resistance, 
      pooled estimates were 98.0% (95% CI 94.5-99.3) for sensitivity and 99.4% 
      (95.7-99.9) for specificity. For the MODS assay of isoniazid resistance with a 
      0.1 mug/mL cutoff, pooled sensitivity was 97.7% (94.4-99.1) and pooled specificity 
      was 95.8% (88.1-98.6), but with a 0.4 mug/mL cutoff, sensitivity decreased to 
      90.0% (84.5-93.7) and specificity increased to 98.6% (96.9-99.4). All assessments 
      of rifampicin and isoniazid resistance with the TLA assay yielded 100% accuracy. 
      Mean turnaround time was 9.9 days (95% CI 4.1-15.8) for the MODS assay and 11.1 
      days (10.1-12.0) for the TLA assay. INTERPRETATION: MODS and TLA assays are 
      inexpensive, rapid alternatives to conventional methods for drug susceptibility 
      testing of M tuberculosis. Our data and expert opinion informed WHO's 
      recommendation for use of selected non-commercial drug susceptibility tests, 
      including MODS, as an interim solution until capacity for genotypic or automated 
      liquid culture drug susceptibility testing is developed. FUNDING: Stop TB 
      Department of WHO.
CI  - Copyright (c) 2010 Elsevier Ltd. All rights reserved.
FAU - Minion, Jessica
AU  - Minion J
AD  - Department of Epidemiology, Biostatistics and Occupational Health, McGill 
      University, Montreal, QC, Canada.
FAU - Leung, Erika
AU  - Leung E
FAU - Menzies, Dick
AU  - Menzies D
FAU - Pai, Madhukar
AU  - Pai M
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PT  - Systematic Review
DEP - 20100831
PL  - United States
TA  - Lancet Infect Dis
JT  - The Lancet. Infectious diseases
JID - 101130150
RN  - 0 (Antitubercular Agents)
SB  - IM
CIN - Lancet Infect Dis. 2010 Oct;10(10):656-8. PMID: 20813586
CIN - Lancet. 2010 Nov 20;376(9754):1712. PMID: 21093635
CIN - Lancet Infect Dis. 2011 Mar;11(3):161-2; author reply 162. PMID: 21371651
MH  - Antitubercular Agents/*pharmacology
MH  - *Drug Resistance, Bacterial
MH  - Humans
MH  - Microbial Sensitivity Tests/economics/methods
MH  - Microscopy/methods
MH  - Mycobacterium tuberculosis/*drug effects/*isolation & purification
MH  - ROC Curve
MH  - Sensitivity and Specificity
MH  - Time Factors
MH  - Tuberculosis, Multidrug-Resistant/*diagnosis/*microbiology
EDAT- 2010/09/04 06:00
MHDA- 2010/10/20 06:00
CRDT- 2010/09/04 06:00
PHST- 2010/09/04 06:00 [entrez]
PHST- 2010/09/04 06:00 [pubmed]
PHST- 2010/10/20 06:00 [medline]
AID - S1473-3099(10)70165-1 [pii]
AID - 10.1016/S1473-3099(10)70165-1 [doi]
PST - ppublish
SO  - Lancet Infect Dis. 2010 Oct;10(10):688-98. doi: 10.1016/S1473-3099(10)70165-1. 
      Epub 2010 Aug 31.