Pooling sputum samples to improve the feasibility of Xpert® MTB/RIF in systematic screening for tuberculosis

J Ho; P Jelfs; P T B Nguyen; V Sintchenko; G J Fox; G B Marks

doi:10.5588/ijtld.16.0846

Pooling sputum samples to improve the feasibility of Xpert^® MTB/RIF in systematic screening for tuberculosis

Int J Tuberc Lung Dis. 2017 May 1;21(5):503-508. doi: 10.5588/ijtld.16.0846.

Authors

J Ho¹, P Jelfs², P T B Nguyen³, V Sintchenko⁴, G J Fox⁵, G B Marks¹

Affiliations

¹ Woolcock Institute of Medical Research, University of Sydney, Sydney, South Western Sydney Clinical School, University of New South Wales, Sydney, Centre for Research Excellence in Tuberculosis, University of Sydney, Sydney.
² Centre for Infectious Diseases and Microbiology, Pathology West and Marie Bashir Institute of Infectious Diseases and Biosecurity, University of Sydney, Sydney, New South Wales, Australia.
³ Woolcock Institute of Medical Research, Hanoi, Viet Nam.
⁴ Centre for Research Excellence in Tuberculosis, University of Sydney, Sydney, Centre for Infectious Diseases and Microbiology, Pathology West and Marie Bashir Institute of Infectious Diseases and Biosecurity, University of Sydney, Sydney, New South Wales, Australia.
⁵ Woolcock Institute of Medical Research, University of Sydney, Sydney, Centre for Research Excellence in Tuberculosis, University of Sydney, Sydney, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.

PMID: 28399964
DOI: 10.5588/ijtld.16.0846

Abstract

Setting: Systematic screening for tuberculosis (TB) using Xpert® MTB/RIF.

Objective: To determine whether pooling sputum samples for Xpert testing may improve the feasibility and cost-effectiveness of Xpert by reducing the number of Xpert tests required.

Design: Mycobacterium tuberculosis-spiked sputum samples at low organism concentrations were used to mimic samples that are more likely to be found in the screening, compared to the diagnostic, setting. Using Xpert, pooled sputum samples were tested from a pooling ratio of 1 in 2 to 1 in 12.

Results: A linear relationship between the pooling ratio and the Xpert MTB cycle threshold (Ct) value was found. As the sputum pooling ratio increased, the Ct value also increased. However, the slope of this increase was relatively small. In the majority of the samples pooled (75/96, 78.1%), Xpert was able to detect M. tuberculosis.

Conclusion: These findings suggest that sputum pooling may be a viable method of improving the feasibility and cost-effectiveness of large-scale sputum testing using Xpert in the TB screening setting.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cost-Benefit Analysis
Feasibility Studies
Humans
Mass Screening / economics
Mass Screening / methods*
Mycobacterium tuberculosis / isolation & purification
Polymerase Chain Reaction / economics
Polymerase Chain Reaction / methods*
Sputum / microbiology*
Tuberculosis / diagnosis*