Cochrane · systematic review · CD014841
Xpert MTB/XDR for detection of pulmonary tuberculosis and resistance to isoniazid, fluoroquinolones, ethionamide, and amikacin
Pillay, S, Steingart, KR, Davies, GR, et al. · Cochrane Database of Systematic Reviews · 2022 · Cochrane Library
Infectious DiseasesAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
25
current version
GRADE rated
20
No studies
5
Included studies
NR
No studies 5 · 20%Ungraded 0 · 0%Very low 8 · 32%Low 2 · 8%Moderate 6 · 24%High 4 · 16%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Summary of findings table, Xpert MTB/XDR for pulmonary tuberculosis
Population: people with presumptive pulmonary tuberculosisRole: an initial testIndex test: Xpert MTB/XDRThreshold for index test: an automated result is providedReference standard: solid or liquid cultureStudies: cross‐sectional
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Test result | no estimate extracted | NR | No studies |
True positivespeople with pulmonary tuberculosis | no estimate extracted | 2 studies · 799 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
False negativespeople incorrectly classified as not having pulmonary tuberculosis | no estimate extracted | 2 studies · 799 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
True negativespeople without pulmonary tuberculosis | no estimate extracted | 2 studies · 429 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
False positivespeople incorrectly classified as having pulmonary tuberculosis | no estimate extracted | 2 studies · 429 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Summary of findings table, Xpert MTB/XDR for isoniazid resistance
Population: adults with pulmonary tuberculosis irrespective of rifampicin resistance (i.e. whether or not their rifampicin resistance status was known), detected as tuberculosis positive by Xpert MTB/XDR Index test: Xpert MTB/XDR Role: an initial test Xpert MTB/XDR must first detect tuberculosis (even if the patient is already tuberculosis‐positive by another test) before it can detect a resistant or susceptible resultThreshold for index test: an automated result is providedPrior tests: before receiving Xpert MTB/XDR, people typically will have received testing with another WHO‐recommended rapid diagnostic test to confirm tuberculosis Reference standard: culture‐based phenotypic drug susceptibility testingStudies: cross‐sectional
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Test result | no estimate extracted | NR | No studies |
True positivespeople with isoniazid resistance | no estimate extracted | 2 studies · 756 participants | Moderate Downgraded: inconsistency, indirectness |
False negativespeople incorrectly classified as not having isoniazid resistance | no estimate extracted | 2 studies · 756 participants | Moderate Downgraded: inconsistency, indirectness |
True negativespeople without isoniazid resistance | no estimate extracted | 2 studies · 327 participants | Moderate Downgraded: inconsistency, indirectness |
False positivespeople incorrectly classified as having isoniazid resistance | no estimate extracted | 2 studies · 327 participants | Moderate Downgraded: inconsistency, indirectness |
Summary of findings table, Xpert MTB/XDR for fluoroquinolone resistance
Population: adults with pulmonary tuberculosis irrespective of rifampicin resistance (i.e. whether or not their rifampicin resistance status was known), detected as tuberculosis positive by Xpert MTB/XDR Index test: Xpert MTB/XDR Role: an initial test Xpert MTB/XDR must first detect tuberculosis (even if the patient is already tuberculosis‐positive by another test) before it can detect a resistant or susceptible resultThreshold for index test: an automated result is providedPrior tests: before receiving Xpert MTB/XDR, people typically will have received testing with another WHO‐recommended rapid diagnostic test to confirm tuberculosis Reference standard: culture‐based phenotypic drug susceptibility testingStudy design: cross‐sectional
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Test result | no estimate extracted | NR | No studies |
True positivespeople with fluoroquinolone resistance | no estimate extracted | 2 studies · 381 participants | High |
False negativespeople incorrectly classified as not having fluoroquinolone resistance | no estimate extracted | 2 studies · 381 participants | High |
True negativespeople without fluoroquinolone resistance | no estimate extracted | 2 studies · 640 participants | Moderate Downgraded: inconsistency, indirectness |
False positivespeople incorrectly classified as having fluoroquinolone resistance | no estimate extracted | 2 studies · 640 participants | Moderate Downgraded: inconsistency, indirectness |
Summary of findings table, Xpert MTB/XDR for ethionamide resistance
Population: adults with pulmonary tuberculosis with known rifampicin resistance, detected as tuberculosis positive by Xpert MTB/XDRRole: an initial testIndex test: Xpert MTB/XDR Xpert MTB/XDR must first detect tuberculosis (even if the patient is already tuberculosis‐positive by another test) before it can detect a resistant or susceptible resultThreshold for index test: an automated result is providedPrior tests: before receiving Xpert MTB/XDR, people typically will have received testing with another WHO‐recommended rapid diagnostic test to confirm tuberculosis Reference standard: genotypic drug susceptibility testingStudy design: cross‐sectional
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Test result | no estimate extracted | NR | No studies |
True positivespeople with ethionamide resistance | no estimate extracted | 1 study · 167 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
False negativespeople incorrectly classified as not having ethionamide resistance | no estimate extracted | 1 study · 167 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
True negativespeople without ethionamide resistance | no estimate extracted | 1 study · 267 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
False positivespeople incorrectly classified as having ethionamide resistance | no estimate extracted | 1 study · 267 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Summary of findings table, Xpert MTB/XDR for amikacin resistance
Population: adults with pulmonary tuberculosis with known rifampicin resistance, detected as tuberculosis‐positive by Xpert MTB/XDR Index test: Xpert MTB/XDR Role: an initial test Xpert MTB/XDR must first detect tuberculosis (even if the patient is already tuberculosis‐positive by another test) before it can detect a resistant or susceptible resultThreshold for index test: an automated result is providedPrior tests: before receiving Xpert MTB/XDR, people typically will have received testing with another WHO‐recommended rapid diagnostic test to confirm tuberculosis Reference standard: culture‐based phenotypic drug susceptibility testingStudies: cross‐sectional
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Test result | no estimate extracted | NR | No studies |
True positivespeople with amikacin resistance | no estimate extracted | 1 study · 65 participants | Low Downgraded: imprecision, inconsistency |
False negativespeople incorrectly classified as not having amikacin resistance | no estimate extracted | 1 study · 65 participants | Low Downgraded: imprecision, inconsistency |
True negativespeople without amikacin resistance | no estimate extracted | 1 study · 425 participants | High |
False positivespeople incorrectly classified as having amikacin resistance | no estimate extracted | 1 study · 425 participants | High |