Sputum PCR-Single-Strand Conformational Polymorphism Test for Same-Day Detection of Pyrazinamide Resistance in Tuberculosis Patients

• Published in: Journal of Clinical Microbiology Vol. 47; no. 9; pp. 2937 - 2943
• Main Authors: Sheen, Patricia, Méndez, Melissa, Gilman, Robert H, Peña, Lizeth, Caviedes, Luz, Zimic, Mirko J, Zhang, Ying, Moore, David A.J, Evans, Carlton A
• Format: Journal Article
• Language: English
• Published: Washington, DC American Society for Microbiology 01.09.2009; American Society for Microbiology (ASM)
• Subjects: Antitubercular Agents - pharmacology; Biological and medical sciences; DNA, Bacterial - genetics; Drug Resistance, Bacterial; Fundamental and applied biological sciences. Psychology; Humans; Microbial Sensitivity Tests - economics; Microbial Sensitivity Tests - methods; Microbiology; Mycobacteriology and Aerobic Actinomycetes; Mycobacterium tuberculosis; Mycobacterium tuberculosis - drug effects; Mycobacterium tuberculosis - genetics; Polymerase Chain Reaction - methods; Polymorphism, Single-Stranded Conformational; Pyrazinamide - pharmacology; Sensitivity and Specificity; Sputum - microbiology; Time Factors; Tuberculosis - microbiology; Human; Polymerase chain reaction; Resistance; Microbiology; Sputum; Antituberculous agent; Antibacterial agent; Detection; Pyrazinamide; Conformation; Polymorphism
• ISSN: 0095-1137; 1098-660X; 1098-660X
• DOI: 10.1128/JCM.01594-08

Pyrazinamide is a first-line drug for treating tuberculosis, but pyrazinamide resistance testing is usually too slow to guide initial therapy, so some patients receive inappropriate therapy. We therefore aimed to optimize and evaluate a rapid molecular test for tuberculosis drug resistance to pyrazinamide. Tuberculosis PCR-single-strand conformational polymorphism (PCR-SSCP) was optimized to test for mutations causing pyrazinamide resistance directly from sputum samples and Mycobacterium tuberculosis isolates. The reliability of PCR-SSCP tests for sputum samples (n = 65) and Mycobacterium tuberculosis isolates (n = 185) from 147 patients was compared with four tests for pyrazinamide resistance: Bactec-460 automated culture, the Wayne biochemical test, DNA sequencing for pncA mutations, and traditional microbiological broth culture. PCR-SSCP provided interpretable results for 96% (46/48) of microscopy-positive sputum samples, 76% (13/17) of microscopy-negative sputum samples, and 100% of Mycobacterium tuberculosis isolates. There was 100% agreement between PCR-SSCP results from sputum samples and Mycobacterium tuberculosis isolates and 100% concordance between 50 blinded PCR-SSCP rereadings by three observers. PCR-SSCP agreement with the four other tests for pyrazinamide resistance varied from 89 to 97%. This was similar to how frequently the four other tests for pyrazinamide resistance agreed with each other: 90 to 94% for Bactec-460, 90 to 95% for Wayne, 92 to 95% for sequencing, and 91 to 95% for broth culture. PCR-SSCP took less than 24 hours and cost approximately $3 to $6, in contrast with the other assays, which took 3 to 14 weeks and cost $7 to $47. In conclusion, PCR-SSCP is a relatively reliable, rapid, and inexpensive test for pyrazinamide resistance that indicates which patients should receive pyrazinamide from the start of therapy, potentially preventing months of inappropriate treatment.