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Use of a Single Xpert MTB/RIF Assay to Determine the Duration of Airborne Isolation in Hospitalized Patients With Suspected Pulmonary Tuberculosis

Published online by Cambridge University Press:  27 March 2018

Husain Poonawala ,
Surbhi Leekha ,
Sandra Medina-Moreno ,
Mala Filippell ,
J. Kristie Johnson ,
Robert R. Redfield  and
Kapil K. Saharia
Husain Poonawala*
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
Surbhi Leekha
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
Sandra Medina-Moreno
Affiliation:
Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
Mala Filippell
Affiliation:
Infection Prevention Department, University of Maryland Medical Center
J. Kristie Johnson
Affiliation:
Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland. (Present affiliation: National Institute for Research in Tuberculosis, Chennai, India [H.P.].)
Robert R. Redfield
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
Kapil K. Saharia
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
*
Address correspondence to Husain Poonawala, No. 1 Sathyamoorthy Road, Chetpet, Chennai 600031, India, ([email protected]).
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Abstract

BACKGROUND

Hospitalized patients with suspected tuberculosis (TB) are placed in airborne isolation until 3 sputum smear samples are negative for acid-fast bacilli (AFB). The Xpert MTB/RIF assay (“Xpert”) nucleic acid amplification test (NAAT) to identify Mycobacterium tuberculosis DNA and resistance to rifampicin is superior to AFB sputum smear microscopy for the diagnosis of TB.

OBJECTIVE

To compare the performance of a single Xpert to AFB smear microscopy for time to airborne infection isolation (AII) discontinuation.

METHODS

Consecutive patients over 17 years of age in AII for suspected pulmonary TB between October 1, 2014, and March 31, 2016, with leftover respiratory AFB samples were enrolled in this study. A single Xpert was performed on the first available sample. Demographic, clinical, and microbiological data were recorded for each patient. We compared the duration of AII using a single Xpert to AFB smear microscopy under multiple theoretical scenarios using Kaplan-Meier cumulative incidence curves and the log-rank test.

RESULTS

In total, 131 samples were included in our performance analysis of the Xpert, and 114 samples were included in our AII analysis. Overall, 81 patients (65%) were immunosuppressed, of whom 46 (37%) were positive for human immunodeficiency virus (HIV). The sensitivity and specificity of Xpert for diagnosis of M. tuberculosis infection were 67% and 100%, respectively. Xpert was negative in all cases of nontuberculous mycobacteria. Use of a single Xpert reduced AII duration from a median of 67 hours per patient to 42 hours with usual reporting, to 26 hours with direct communication, and to 12 hours with immediate testing.

CONCLUSIONS

A single negative Xpert result can reduce AII duration compared to the AFB smear microscopy technique under multiple theoretical scenarios.

Infect Control Hosp Epidemiol 2018;39:590–595

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 5 , May 2018 , pp. 590 - 595
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

PREVIOUS PRESENTATION. The results of this study were presented at the Infectious Diseases Society of America Meeting 2016, on October 27, 2016, in New Orleans, Louisiana (abstract 544).

References

REFERENCES

1. Centers for Disease Control and Prevention. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care settings, 2005. MMWR Recomm Rep 2005;54(RR-17):1–141.Google Scholar
2. Jorgensen, JH, Pfaller, MA, Carroll, KC, et al. Manual of Clinical Microbiology, 11th ed. Washington, DC: American Society of Microbiology; 2015.CrossRefGoogle Scholar
3. Behr, MA, Warren, SA, Salamon, H, et al. Transmission of Mycobacterium tuberculosis from patients smear-negative for acid-fast bacilli. Lancet 1999;353:444–449.CrossRefGoogle ScholarPubMed
4. Hernandez-Garduno, E, Cook, V, Kunimoto, D, Elwood, RK, Black, WA, FitzGerald, JM. Transmission of tuberculosis from smear negative patients: a molecular epidemiology study. Thorax 2004;59:286–290.CrossRefGoogle ScholarPubMed
5. Tostmann, A, Kik, SV, Kalisvaart, NA, et al. Tuberculosis transmission by patients with smear-negative pulmonary tuberculosis in a large cohort in the Netherlands. Clin Infect Dis 2008;47:1135–1142.Google Scholar
6. Abad, C, Fearday, A, Safdar, N. Adverse effects of isolation in hospitalised patients: a systematic review. J Hosp Infect 2010;76:97–102.Google Scholar
7. Thomas, BS, Bello, EF, Seto, TB. Prevalence and predictors of compliance with discontinuation of airborne isolation in patients with suspected pulmonary tuberculosis. Infect Control Hosp Epidemiol 2013;34:967–972.Google Scholar
8. Hughes, R, Wonderling, D, Li, B, Higgins, B. The cost effectiveness of nucleic acid amplification techniques for the diagnosis of tuberculosis. Respir Med 2012;106:300–307.CrossRefGoogle ScholarPubMed
9. Marks, SM, Cronin, W, Venkatappa, T, et al. The health-system benefits and cost-effectiveness of using Mycobacterium tuberculosis direct nucleic acid amplification testing to diagnose tuberculosis disease in the United States. Clin Infect Dis 2013;57:532–542.CrossRefGoogle ScholarPubMed
10. Millman, AJ, Dowdy, DW, Miller, CR, et al. Rapid molecular testing for TB to guide respiratory isolation in the US: a cost–benefit analysis. PLoS One 2013;8:e79669.Google Scholar
11. Boehme, CC, Nabeta, P, Hillemann, D, et al. Rapid molecular detection of tuberculosis and rifampin resistance. N Engl J Med 2010;363:1005–1015.Google Scholar
12. Steingart, KR, Sohn, H, Schiller, I, et al. Xpert(R) MTB/RIF assay for pulmonary tuberculosis and rifampicin resistance in adults. Cochrane Database Syst Rev 2013;1(1):CD009593.Google Scholar
13. Division of Microbiology Devices, Office of In Vitro Diagnostics and Radiological Health, Center for Devices and Radiological Health, Food and Drug Administration. Revised device labeling for the Cepheid Xpert MTB/RIF assay for detecting Mycobacterium tuberculosis . MMWR Morb Mortal Wkly Rep 2015;64:193.Google Scholar
14. Cowan, JF, Chandler, AS, Kracen, E, et al. Clinical impact and cost-effectiveness of Xpert MTB/RIF testing in hospitalized patients with presumptive pulmonary tuberculosis in the United States. Clin Infect Dis 2017;64:482–489.Google Scholar
15. Chaisson, LH, Roemer, M, Cantu, D, et al. Impact of GeneXpert MTB/RIF assay on triage of respiratory isolation rooms for inpatients with presumed tuberculosis: a hypothetical trial. Clin Infect Dis 2014;59:1353–1360.Google Scholar
16. Lippincott, CK, Miller, MB, Popowitch, EB, Hanrahan, CF, Van Rie, A. Xpert MTB/RIF assay shortens airborne isolation for hospitalized patients with presumptive tuberculosis in the United States. Clin Infect Dis 2014;59:186–192.CrossRefGoogle ScholarPubMed
17. Luetkemeyer, AF, Firnhaber, C, Kendall, MA, et al. Evaluation of Xpert MTB/RIF versus AFB smear and culture to identify pulmonary tuberculosis in patients with suspected tuberculosis from low and higher prevalence settings. Clin Infect Dis 2016;62:1081–1088.Google Scholar
18. Adjemian, J, Olivier, KN, Seitz, AE, Holland, SM, Prevots, DR. Prevalence of nontuberculous mycobacterial lung disease in US Medicare beneficiaries. Am J Respir Crit Care Med 2012;185:881–886.Google Scholar
19. Banerjee, R, Teng, CB, Cunningham, SA, et al. Randomized trial of rapid multiplex polymerase chain reaction-based blood culture identification and susceptibility testing. Clin Infect Dis 2015;61:1071–1080.CrossRefGoogle ScholarPubMed
20. Choi, HW, Miele, K, Dowdy, D, Shah, M. Cost-effectiveness of Xpert(R) MTB/RIF for diagnosing pulmonary tuberculosis in the United States. Int J Tuberc Lung Dis 2013;17:1328–1335.Google Scholar