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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, (husain.poonawala@gmail.com).
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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).

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