PCR-Single-Strand Conformational Polymorphism Method for Rapid Detection of Rifampin-Resistant Mycobacterium tuberculosis: Systematic Review and Meta-Analysis

• Published in: Journal of Clinical Microbiology Vol. 48; no. 10; pp. 3635 - 3640
• Main Authors: Xu, Hong-Bin, Jiang, Rui-Hai, Sha, Wei, Li, Ling, Xiao, He-Ping
• Format: Journal Article
• Language: English
• Published: Washington, DC American Society for Microbiology 01.10.2010; American Society for Microbiology (ASM)
• Subjects: Antitubercular Agents - pharmacology; Bacteriology; Biological and medical sciences; DNA, Bacterial - genetics; Drug Resistance, Bacterial; Fundamental and applied biological sciences. Psychology; Humans; Microbial Sensitivity Tests - methods; Microbiology; Miscellaneous; Mycobacteriology and Aerobic Actinomycetes; Mycobacterium; Mycobacterium tuberculosis; Mycobacterium tuberculosis - drug effects; Mycobacterium tuberculosis - genetics; Mycobacterium tuberculosis - isolation & purification; Polymerase Chain Reaction - methods; Polymorphism, Single-Stranded Conformational; Rifampin - pharmacology; Sensitivity and Specificity; Time Factors; Tuberculosis - microbiology; Taxonomy; Review; Metaanalysis; Polymerase chain reaction; Resistance; Antibiotic; Rapid technique; Rifampicin; Mycobacterium tuberculosis; Mycobacteriales; Mycobacteriaceae; Bacteria; Actinomycetes; Antituberculous agent; Protein synthesis inhibitor; Antibacterial agent; Conformation; Polymorphism
• ISSN: 0095-1137; 1098-660X; 1098-660X
• DOI: 10.1128/JCM.00960-10

The reference standard methods for drug susceptibility testing of Mycobacterium tuberculosis, such as culture on Lowenstein-Jensen or Middlebrook 7H10/11 medium, are very slow to give results; and due to the emergence of multidrug-resistant M. tuberculosis and extensively drug-resistant M. tuberculosis, there is an urgent demand for new, rapid, and accurate drug susceptibility testing methods. PCR-single-strand conformational polymorphism (PCR-SSCP) analysis has been proposed as a rapid method for the detection of resistance to rifampin, but its accuracy has not been systematically evaluated. We performed a systematic review and meta-analysis to evaluate the accuracy of PCR-SSCP analysis for the detection of rifampin-resistant tuberculosis. We searched the Medline, Embase, Web of Science, BIOSIS, and LILACS databases and contacted authors if additional information was required. Ten studies met our inclusion criteria for rifampin resistance detection. We applied the summary receiver operating characteristic (SROC) curve to perform the meta-analysis and to summarize diagnostic accuracy. The sensitivity of PCR-SSCP analysis for the rapid detection of rifampin-resistant tuberculosis was 0.79 (95% confidence interval [CI], 0.75 to 0.82), the specificity was 0.96 (95% CI, 0.94 to 0.98), the positive likelihood ratio was 16.10 (95% CI, 5.87 to 44.13), the negative likelihood ratio was 0.20 (95% CI, 0.10 to 0.40), and the diagnostic odds ratio was 100.93 (95% CI, 31.95 to 318.83). PCR-SSCP analysis is a sensitive and specific test for the rapid detection of rifampin-resistant M. tuberculosis. Additional studies in countries with a high prevalence of multidrug-resistant M. tuberculosis and also cost-effectiveness analysis are required in order to obtain a complete picture on the utility of this method for rapid drug resistance detection in M. tuberculosis.