Use of the amplified Mycobacterium tuberculosis direct test in a public health laboratory: Test performance and impact on clinical care

Renata L. Guerra, Nancy M. Hooper, James F. Baker, Roya Alborz, Derek T. Armstrong, Gina Maltas, Julia A. Kiehlbauch, Susan E. Dorman

Research output: Contribution to journalArticle

Abstract

Background: The Amplified Mycobacterium tuberculosis Direct Test (MTD; Gen-Probe; San Diego, CA) is a nucleic-acid amplification test for rapid pulmonary tuberculosis (PTB) diagnosis. In a routine public health setting, test accuracy and impact on clinical decisions are unknown. Methods: Retrospectively, we evaluated MTD accuracy and impact on clinical decisions in a public health setting. To estimate MTD accuracy, mycobacterial culture was used as the "gold standard." To evaluate MTD impact on clinical decisions, concordance of clinician presumptive diagnosis (at time of MTD and smear availability) and definitive diagnosis, and duration of nonindicated tuberculosis therapy were determined for smear-positive PTB suspects in a period of MTD availability (MTD group) and a prior period of MTD nonavailability (non-MTD group). Results: A total of 1,151 respiratory specimens from 638 PTB suspects were analyzed. MTD sensitivity, specificity, positive predictive value, and negative predictive value were 91.7%, 98.7%, 96.7%, and 96.5% overall, respectively; and 98.7%, 97.8%, 98.7%, and 97.8% for smear-positive patients; and 62.2%, 98.9%, 85.2%, and 96.1% for smear-negative patients. In the MTD group, concordance between definitive and clinician presumptive diagnoses was 78% (95% confidence interval [CI], 64 to 88%), similar to that for the non-MTD group (79%; 95% CI, 68.4 to 89.6%). However, concordance between definitive diagnosis and the MTD test was 98% (95% CI, 94.1 to 100%). Median duration of nonindicated tuberculosis treatment was 6 days for the MTD group vs 31 days for the non-MTD group (p = 0.002). Conclusion: In this public health setting, MTD was accurate and rapidly detected more than half of the smear-negative PTB cases. For smear-positive PTB suspects, MTD had excellent concordance with definitive diagnosis, but clinicians often inappropriately initiated TB therapy despite a negative MTD result.

Original languageEnglish (US)
Pages (from-to)946-951
Number of pages6
JournalChest
Volume132
Issue number3
DOIs
StatePublished - Sep 2007

Fingerprint

Mycobacterium tuberculosis
Pulmonary Tuberculosis
Public Health
Confidence Intervals
Tuberculosis
Nucleic Acid Amplification Techniques
Therapeutics
Sensitivity and Specificity

Keywords

  • Amplified
  • Diagnosis
  • Mycobacterium tuberculosis direct test
  • Respiratory specimens
  • Tuberculosis

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Guerra, R. L., Hooper, N. M., Baker, J. F., Alborz, R., Armstrong, D. T., Maltas, G., ... Dorman, S. E. (2007). Use of the amplified Mycobacterium tuberculosis direct test in a public health laboratory: Test performance and impact on clinical care. Chest, 132(3), 946-951. https://doi.org/10.1378/chest.06-2959

Use of the amplified Mycobacterium tuberculosis direct test in a public health laboratory : Test performance and impact on clinical care. / Guerra, Renata L.; Hooper, Nancy M.; Baker, James F.; Alborz, Roya; Armstrong, Derek T.; Maltas, Gina; Kiehlbauch, Julia A.; Dorman, Susan E.

In: Chest, Vol. 132, No. 3, 09.2007, p. 946-951.

Research output: Contribution to journalArticle

Guerra, RL, Hooper, NM, Baker, JF, Alborz, R, Armstrong, DT, Maltas, G, Kiehlbauch, JA & Dorman, SE 2007, 'Use of the amplified Mycobacterium tuberculosis direct test in a public health laboratory: Test performance and impact on clinical care', Chest, vol. 132, no. 3, pp. 946-951. https://doi.org/10.1378/chest.06-2959
Guerra, Renata L. ; Hooper, Nancy M. ; Baker, James F. ; Alborz, Roya ; Armstrong, Derek T. ; Maltas, Gina ; Kiehlbauch, Julia A. ; Dorman, Susan E. / Use of the amplified Mycobacterium tuberculosis direct test in a public health laboratory : Test performance and impact on clinical care. In: Chest. 2007 ; Vol. 132, No. 3. pp. 946-951.
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abstract = "Background: The Amplified Mycobacterium tuberculosis Direct Test (MTD; Gen-Probe; San Diego, CA) is a nucleic-acid amplification test for rapid pulmonary tuberculosis (PTB) diagnosis. In a routine public health setting, test accuracy and impact on clinical decisions are unknown. Methods: Retrospectively, we evaluated MTD accuracy and impact on clinical decisions in a public health setting. To estimate MTD accuracy, mycobacterial culture was used as the {"}gold standard.{"} To evaluate MTD impact on clinical decisions, concordance of clinician presumptive diagnosis (at time of MTD and smear availability) and definitive diagnosis, and duration of nonindicated tuberculosis therapy were determined for smear-positive PTB suspects in a period of MTD availability (MTD group) and a prior period of MTD nonavailability (non-MTD group). Results: A total of 1,151 respiratory specimens from 638 PTB suspects were analyzed. MTD sensitivity, specificity, positive predictive value, and negative predictive value were 91.7{\%}, 98.7{\%}, 96.7{\%}, and 96.5{\%} overall, respectively; and 98.7{\%}, 97.8{\%}, 98.7{\%}, and 97.8{\%} for smear-positive patients; and 62.2{\%}, 98.9{\%}, 85.2{\%}, and 96.1{\%} for smear-negative patients. In the MTD group, concordance between definitive and clinician presumptive diagnoses was 78{\%} (95{\%} confidence interval [CI], 64 to 88{\%}), similar to that for the non-MTD group (79{\%}; 95{\%} CI, 68.4 to 89.6{\%}). However, concordance between definitive diagnosis and the MTD test was 98{\%} (95{\%} CI, 94.1 to 100{\%}). Median duration of nonindicated tuberculosis treatment was 6 days for the MTD group vs 31 days for the non-MTD group (p = 0.002). Conclusion: In this public health setting, MTD was accurate and rapidly detected more than half of the smear-negative PTB cases. For smear-positive PTB suspects, MTD had excellent concordance with definitive diagnosis, but clinicians often inappropriately initiated TB therapy despite a negative MTD result.",
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AU - Armstrong, Derek T.

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N2 - Background: The Amplified Mycobacterium tuberculosis Direct Test (MTD; Gen-Probe; San Diego, CA) is a nucleic-acid amplification test for rapid pulmonary tuberculosis (PTB) diagnosis. In a routine public health setting, test accuracy and impact on clinical decisions are unknown. Methods: Retrospectively, we evaluated MTD accuracy and impact on clinical decisions in a public health setting. To estimate MTD accuracy, mycobacterial culture was used as the "gold standard." To evaluate MTD impact on clinical decisions, concordance of clinician presumptive diagnosis (at time of MTD and smear availability) and definitive diagnosis, and duration of nonindicated tuberculosis therapy were determined for smear-positive PTB suspects in a period of MTD availability (MTD group) and a prior period of MTD nonavailability (non-MTD group). Results: A total of 1,151 respiratory specimens from 638 PTB suspects were analyzed. MTD sensitivity, specificity, positive predictive value, and negative predictive value were 91.7%, 98.7%, 96.7%, and 96.5% overall, respectively; and 98.7%, 97.8%, 98.7%, and 97.8% for smear-positive patients; and 62.2%, 98.9%, 85.2%, and 96.1% for smear-negative patients. In the MTD group, concordance between definitive and clinician presumptive diagnoses was 78% (95% confidence interval [CI], 64 to 88%), similar to that for the non-MTD group (79%; 95% CI, 68.4 to 89.6%). However, concordance between definitive diagnosis and the MTD test was 98% (95% CI, 94.1 to 100%). Median duration of nonindicated tuberculosis treatment was 6 days for the MTD group vs 31 days for the non-MTD group (p = 0.002). Conclusion: In this public health setting, MTD was accurate and rapidly detected more than half of the smear-negative PTB cases. For smear-positive PTB suspects, MTD had excellent concordance with definitive diagnosis, but clinicians often inappropriately initiated TB therapy despite a negative MTD result.

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