Volume 27, Number 3—March 2021
Synopsis
Systematic Review of Pooling Sputum as an Efficient Method for Xpert MTB/RIF Tuberculosis Testing during the COVID-19 Pandemic
Table 2
Study |
Pooling ratio |
Test results, no. |
Sensitivity,
% (95% CI) |
Specificity,
% (95% CI) |
|||
---|---|---|---|---|---|---|---|
True pos† |
False pos‡ |
False neg† |
True neg‡ |
||||
(11) | 1:5 (Cult neg/SM pos) | 20 | NA | 0 | NA | 100 (80–100) | NR |
1:5 (Cult pos/SM neg) |
13 |
NA |
4 |
NA |
76 (50–92) |
NR |
|
(12) |
1:4 |
80 |
1 |
5 |
96 |
94 (87–98) |
99 (94–100) |
(13) | 1:2 | 14 | NA | 2 | NA | 88 (62–98) | NR |
1:4 | 14 | NA | 2 | NA | 88 (62–98) | NR | |
1:6 | 11 | NA | 5 | NA | 69 (41–98) | NR | |
1:8 | 10 | NA | 6 | NA | 63 (35–85) | NR | |
1:10 | 13 | NA | 3 | NA | 81 (54–96) | NR | |
1:12 |
13 |
NA |
3 |
NA |
81 (54–96) |
NR |
|
(14) |
1:2 |
95 |
NA |
4 |
NA |
96 (90–99) |
NR |
(15) |
1:4 |
73 |
0 |
0 |
80 |
100 (95–100) |
100 (96–100) |
(10) | 1:4 | 19 | NA | 1 | NA | 95 (75–100) | NR |
1:8 | 20 | NA | 0 | NA | 100 (83–100) | NR | |
1:12 | 16 | NA | 4 | NA | 80 (56–94) | NR | |
1:16 | 39 | 0 | 1 | 0 | 98 (87–100) | NR |
*Xpert MTB/RIF and Ultra, Cepheid (https://www.cepheid.com). Cult, culture, NA, not applicable; neg, negative; NR, not reported; pos, positive; SM, smear. †At least one of the patients included in the pool had an Xpert-positive test. ‡All patients included in the pool were Xpert-negative in the individual tests.
References
- World Health Organization. WHO monitoring of Xpert MTB/RIF roll-out. Geneva: The Organization; 2019 [cited 2020 Apr 1]. https://www.who.int/tb/areas-of-work/laboratory/mtb-rif-rollout/en
- Van Deun A, Tahseen S, Affolabi D, Hossain MA, Joloba ML, Angra PK, et al. Sputum smear microscopy in the Xpert® MTB/RIF era. Int J Tuberc Lung Dis. 2019;23:12–8. DOIPubMedGoogle Scholar
- World Health Organization. WHO: Global TB progress at risk. Geneva: The Organization; 2020. [cited 2020 Nov 1]. https://www.who.int/news/item/14-10-2020-who-global-tb-progress-at-risk
- Emmanuel JC, Bassett MT, Smith HJ, Jacobs JA. Pooling of sera for human immunodeficiency virus (HIV) testing: an economical method for use in developing countries. J Clin Pathol. 1988;41:582–5. DOIPubMedGoogle Scholar
- Morandi PA, Schockmel GA, Yerly S, Burgisser P, Erb P, Matter L, et al. Detection of human immunodeficiency virus type 1 (HIV-1) RNA in pools of sera negative for antibodies to HIV-1 and HIV-2. J Clin Microbiol. 1998;36:1534–8. DOIPubMedGoogle Scholar
- Peeling RW, Toye B, Jessamine P, Gemmill I. Pooling of urine specimens for PCR testing: a cost saving strategy for Chlamydia trachomatis control programmes. Sex Transm Infect. 1998;74:66–70. DOIPubMedGoogle Scholar
- Mine H, Emura H, Miyamoto M, Tomono T, Minegishi K, Murokawa H, et al.; Japanese Red Cross NAT Research Group. High throughput screening of 16 million serologically negative blood donors for hepatitis B virus, hepatitis C virus and human immunodeficiency virus type-1 by nucleic acid amplification testing with specific and sensitive multiplex reagent in Japan. J Virol Methods. 2003;112:145–51. DOIPubMedGoogle Scholar
- Lindan C, Mathur M, Kumta S, Jerajani H, Gogate A, Schachter J, et al. Utility of pooled urine specimens for detection of Chlamydia trachomatis and Neisseria gonorrhoeae in men attending public sexually transmitted infection clinics in Mumbai, India, by PCR. J Clin Microbiol. 2005;43:1674–7. DOIPubMedGoogle Scholar
- Westreich DJ, Hudgens MG, Fiscus SA, Pilcher CD. Optimizing screening for acute human immunodeficiency virus infection with pooled nucleic acid amplification tests. J Clin Microbiol. 2008;46:1785–92. DOIPubMedGoogle Scholar
- Santos P, Santos A, Verma R, Oliveira R, Camioli C, Lemos E, et al. The utility of pooling sputum samples for mass screening for tuberculosis in prisons using Xpert MTB/RIF Ultra. In: 50th World Conference on International Union Against Tuberculosis and Lung Disease; 2019 Oct 30–Nov 2; Hyderabad, India. Abstract SOA-01-1001-31. Int J Tuberc Lung Dis. 2019;23:S110–1 https://hyderabad.worldlunghealth.org/wp-content/uploads/2019/11/20191101_UNION2019_Abstracts_Final.pdf cited 2020 Mar 30.
- Zishiri V, Chihota V, McCarthy K, Charalambous S, Churchyard GJ, Hoffmann CJ. Pooling sputum from multiple individuals for Xpert® MTB/RIF testing: a strategy for screening high-risk populations. Int J Tuberc Lung Dis. 2015;19:87–90. DOIPubMedGoogle Scholar
- Abdurrahman ST, Mbanaso O, Lawson L, Oladimeji O, Blakiston M, Obasanya J, et al. Testing pooled sputum with Xpert MTB/RIF for diagnosis of pulmonary tuberculosis to increase affordability in low-income countries. J Clin Microbiol. 2015;53:2502–8. DOIPubMedGoogle Scholar
- Ho J, Jelfs P, Nguyen PTB, Sintchenko V, Fox GJ, Marks GB. Pooling sputum samples to improve the feasibility of Xpert® MTB/RIF in systematic screening for tuberculosis. Int J Tuberc Lung Dis. 2017;21:503–8. DOIPubMedGoogle Scholar
- Phuong NTB, Anh NT, Van Son N, Sintchenko V, Ho J, Fox GJ, et al. Effect of two alternative methods of pooling sputum prior to testing for tuberculosis with genexpert MTB/RIF. BMC Infect Dis. 2019;19:347. DOIPubMedGoogle Scholar
- Chry M, Smelyanskaya M, Ky M, Codlin AJ, Cazabon D, Tan Eang M, et al. Can the high sensitivity of Xpert MTB/RIF Ultra be harnessed to save cartridge costs? Results from a pooled sputum evaluation in Cambodia. Trop Med Infect Dis. 2020;5:27. DOIPubMedGoogle Scholar
- Chakravorty S, Simmons AM, Rowneki M, Parmar H, Cao Y, Ryan J, et al. The new Xpert MTB/RIF Ultra: improving detection of Mycobacterium tuberculosis and resistance to rifampin in an assay suitable for point-of-care testing. MBio. 2017;8:e00812–7. DOIPubMedGoogle Scholar
- World Health Organization. Automated real-time nucleic acid amplification technology for rapid and simultaneous detection of tuberculosis and rifampicin resistance: Xpert MTB/RIF assay for the diagnosis of pulmonary and extrapulmonary TB in adults and children: policy update. Geneva: The Organization; 2013 [cited 2020 Apr 1]. https://apps.who.int/iris/bitstream/handle/10665/112472/9789241506335_eng.pdf
- World Health Organization. Global tuberculosis report 2019. Geneva: The Organization; 2019. [cited 2020 Apr 1]. https://apps.who.int/iris/bitstream/handle/10665/329368/9789241565714-eng.pdf
- Dowdy DW, Basu S, Andrews JR. Is passive diagnosis enough? The impact of subclinical disease on diagnostic strategies for tuberculosis. Am J Respir Crit Care Med. 2013;187:543–51. DOIPubMedGoogle Scholar
Page created: December 22, 2020
Page updated: February 23, 2021
Page reviewed: February 23, 2021
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.