Ali Albay, Mustafa Güney, Kemal Tekin, Özgül Kısa, Ali Korhan Sığ

Pulmoner ve ekstrapulmoner örneklerde tüberkülozun erken tanısı ve rifampisin direncinin tespiti için geneXpert MTB/RIF testinin değerlendirilmesi

Amaç: Mycobacterium tuberculosis kompleks’in çok ilaca dirençli suşlarının ortaya çıkması ve tüberkülozun yeniden önem kazanması, yeni tanı ve antibiyotik duyarlılık test yöntemlerinin geliştirilmesini teşvik etmiştir. Biz de çalışmamızda bu amaçla son zamanlarda geliştirilmiş bir tanı yöntemi olan GeneXpert MTB/RIF testini, klinik örneklerden M. tuberculosis kompleksin tanımlanması ve rifampisin direncinin saptanmasında değerlendirdik. Gereç ve Yöntem: Çalışmamızda klasik ve tam otomatize kültür yöntemleri ile GeneXpert MTB/RIF testi karşılaştırıldı. 389 adet çeşitli klinik örneklerin (171 adet pulmoner ve 218 adet ekstrapulmoner) kültürleri, BACTEC MGIT 960 kültür sistemi ve Löwenstein-Jensen besiyeri ile yapıldı. Aynı zamanda GeneXpert MTB/RIF sistemi ile bu klinik örnekler test edildi. Bulgular: GeneXpert MTB/RIF testi ile 23 örnek, Löwenstein-Jensen besiyeri ve BACTEC MGIT 960 kültür sistemi ile 22 hasta örneği pozitif olarak tespit edildi. İki M. tuberculosis kompleks suşu GeneXpert MTB/RIF testi ile başlangıçta rifampisin dirençli olarak belirlendi, ancak testin tekrarlanması ile iki suştan biri duyarlı olarak tespit edildi. Kültür sonuçlarına göre hem yayma negatif hem de pozitif pulmoner örnekler için GeneXpert MTB/RIF testinin duyarlılığı %100 (16/16) olarak bulundu. Testin ekstrapulmoner örnekler için duyarlılığı ve özgüllüğü, sırasıyla %83.3 ve %99.5 olarak belirlendi.Sonuç: GeneXpert MTB/RIF testinin, tüberkülozun erken tanısında ve çok ilaca dirençli suşların tespitindeki başarılı sonuçlarıyla tüberküloz laboratuvarlarında etkin bir şekilde kullanılabilecek otomatize moleküler bir tanı testi olduğu düşünülmektedir.

Anahtar Kelimeler:

Tüberküloz, GeneXpert MTB/RIF, rifampisin direnci

Evaluation of the geneXpert MTB/RIF assay for early diagnosis of tuberculosis and detection of rifampicin resistance in pulmonary and extrapulmonary specimens

Purpose: The emerging of multi-drug resistant strains of Mycobacterium tuberculosis complex and the resurgence of tuberculosis have forced new methods for diagnosis and antimicrobial susceptibility to be developed. In this study, we evaluated a recently marketed diagnostic technique, GeneXpert MTB/RIF test, in terms of identifying Mycobacterium tuberculosis complex and detecting rifampicin resistance from clinical samples. Material and Methods: In our study, GeneXpert MTB/RIF assay was compared with conventional and automated culture methods. 389 various clinical samples (171 pulmonary and 218 ekstrapulmonary samples) were cultured with BACTEC MGIT 960 culture system and Löwenstein-Jensen medium and were tested with GeneXpert MTB / RIF test. Results: 23 samples were positive for Mycobacterium tuberculosis complex by GeneXpert MTB/RIF test, but 22 samples were positive for Löwenstein-Jensen medium and BACTEC MGIT 960 culture system. 2 of 23 samples were detected rifampicin resistant at the first study, but re-studying of these samples resulted as rifampicin resistant for only one sample. According to culture findings of all pulmonary samples, the sensitivity and specificity for GeneXpert MTB / RIF test were both 100% (16/16). The sensitivity and specificity for extrapulmonary samples were 83.3% and 99.5%, respectively.Conclusion: GeneXpert MTB / RIF test is an effectual automated molecular diagnostic technique with its successful and reliable performance in early diagnosis of tuberculosis and detecting multi-drug resistant strains.

Keywords:

Tuberculosis, GeneXpert MTB/RIF, MDR-TB,

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