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首页> 外文期刊>Journal of Clinical Microbiology >Testing Pooled Sputum with Xpert MTB/RIF for Diagnosis of Pulmonary Tuberculosis To Increase Affordability in Low-Income Countries
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Testing Pooled Sputum with Xpert MTB/RIF for Diagnosis of Pulmonary Tuberculosis To Increase Affordability in Low-Income Countries

机译：用Xpert MTB / RIF测试痰液以诊断肺结核以增加低收入国家的负担能力

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Tuberculosis (TB) is a global public health problem, with the highest burden occurring in low-income countries. In these countries, the use of more sensitive diagnostics, such as Xpert MTB/RIF (Xpert), is still limited by costs. A cost-saving strategy to diagnose other diseases is to pool samples from various individuals and test them with single tests. The samples in positive pool samples are then retested individually to identify the patients with the disease. We assessed a pooled testing strategy to optimize the affordability of Xpert for the diagnosis of TB. Adults with presumptive TB attending hospitals or identified by canvassing of households in Abuja, Nigeria, were asked to provide sputum for individual and pooled (4 per pool) testing. The agreement of the results of testing of individual and pooled samples and costs were assessed. A total of 738 individuals submitted samples, with 115 (16%) being Mycobacterium tuberculosis positive. Valid Xpert results for individual and pooled samples were available for 718 specimens. Of these, testing of pooled samples detected 109 (96%) of 114 individual M. tuberculosis-positive samples, with the overall agreement being 99%. Xpert semiquantitative M. tuberculosis levels had a positive correlation with the smear grades, and the individual sample-positive/pooled sample-negative results were likely due to the M. tuberculosis concentration being below the detection limit. The strategy reduced cartridge costs by 31%. Savings were higher with samples from individuals recruited in the community, where the proportion of positive specimens was low. The results of testing of pooled samples had a high level of agreement with the results of testing of individual samples, and use of the pooled testing strategy reduced costs and has the potential to increase the affordability of Xpert in countries with limited resources.
机译：结核病是一个全球性的公共卫生问题，负担最重的是低收入国家。在这些国家/地区，使用更敏感的诊断程序（例如Xpert MTB / RIF（Xpert））仍然受到成本的限制。诊断其他疾病的一种节省成本的策略是汇集不同个体的样本并通过一次测试对其进行测试。然后分别对阳性池样本中的样本进行重新测试，以识别患有该疾病的患者。我们评估了综合测试策略，以优化Xpert用于结核病诊断的负担能力。假定患有结核病的成年人在医院就诊，或者通过尼日利亚阿布贾家庭的拉票确定了成年人的身材，并要求他们提供痰液以进行单独检查和合并检查（每个检查池4个）。评估了单个样本和合并样本的测试结果与成本的一致性。总共738个人提交了样本，其中115（16％）是结核分枝杆菌阳性。对于718个样本，单个样本和合并样本的有效Xpert结果可用。在这些样本中，对114份结核分枝杆菌阳性的单个样本中的109份（96％）进行了检测，总体符合率为99％。 Xpert结核分枝杆菌的半定量水平与涂片等级呈正相关，并且由于结核分枝杆菌的浓度低于检测极限，单个样品阳性/合并样品阴性的结果很可能。该策略将墨盒成本降低了31％。从社区招募的个体样本中，阳性样本的比例很低，节省的费用更高。合并样品的测试结果与单个样品的测试结果高度吻合，并且使用合并测试策略可以降低成本，并有可能在资源有限的国家/地区提高Xpert的承受能力。

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