Systematic Review of Pooling Sputum as an Efficient Method for Xpert MTB/RIF Tuberculosis Testing during the COVID-19 Pandemic.
GeneXpert-based testing with Xpert MTB/RIF or Ultra assays is essential for tuberculosis diagnosis. However, testing may be affected by cartridge and staff shortages. More efficient testing strategies could help, especially during the coronavirus disease pandemic. We searched the literature to systematically review whether GeneXpert-based testing of pooled sputum samples achieves sensitivity and specificity similar to testing individual samples; this method could potentially save time and preserve the limited supply of cartridges. From 6 publications, we found 2-sample pools using Xpert MTB/RIF had 87.5% and 96.0% sensitivity (average sensitivity 94%; 95% CI 89.0%-98.0%) (2 studies). Four-sample pools averaged 91% sensitivity with Xpert MTB/RIF (2 studies) and 98% with Ultra (2 studies); combining >4 samples resulted in lower sensitivity. Two studies reported that pooling achieved 99%-100% specificity and 27%-31% in cartridge savings. Our results show that pooling may improve efficiency of GeneXpert-based testing.
['Cuevas|Luis E|LE|', 'Santos|Victor S|VS|', 'Lima|Shirley Verônica Melo Almeida|SVMA|', 'Kontogianni|Konstantina|K|', 'Bimba|John S|JS|', 'Iem|Vibol|V|', 'Dominguez|Jose|J|', 'Adams|Emily|E|', 'Atienzar|Ana Cubas|AC|', 'Edwards|Thomas|T|', 'Squire|S Bertel|SB|', 'Hall|Patricia J|PJ|', 'Creswell|Jacob|J|']
D000086382:COVID-19 D003362:Cost-Benefit Analysis D006801:Humans D025202:Molecular Diagnostic Techniques D009169:Mycobacterium tuberculosis D000086402:SARS-CoV-2 D012680:Sensitivity and Specificity D013048:Specimen Handling D013183:Sputum D014376:Tuberculosis
systematic reviews pooling tuberculosis COVID-19 pandemic coronavirus disease SARS-CoV-2 TB Xpert MTB/RIF testing antimicrobial resistance bacteria diagnostics mycobacteria severe acute respiratory syndrome coronavirus 2 tuberculosis and other mycobacteria viruses