Xpert MTB/RIF assay for the diagnosis of rifampicin resistance in different regions: a meta-analysis.

Background: To estimate the diagnostic accuracy of Xpert MTB/RIF for rifampicin resistance in different regions, a meta-analysis was carried out.

Methods: Several databases were searched for relevant studies up to March 3, 2019. A bivariate random-effects model was used to estimate the diagnostic accuracy.

Results: We identified 97 studies involving 26,037 samples for the diagnosis of rifampicin resistance. The pooled sensitivity, specificity and AUC of Xpert MTB/RIF for rifampicin resistance detection were 0.93 (95% CI 0.90-0.95), 0.98 (95% CI 0.96-0.98) and 0.99 (95% CI 0.97-0.99), respectively. For different regions, the pooled sensitivity were 0.94(95% CI 0.89-0.97) and 0.92 (95% CI 0.88-0.94), the pooled specificity were 0.98 (95% CI 0.94-1.00) and 0.98 (95% CI 0.96-0.99), and the AUC were 0.99 (95% CI 0.98-1.00) and 0.99 (95% CI 0.97-0.99) in high and middle/low income countries, respectively. The pooled sensitivity were 0.91 (95% CI 0.87-0.94) and 0.91 (95% CI 0.86-0.94), the pooled specificity were 0.98 (95% CI 0.96-0.99) and 0.98 (95% CI 0.96-0.99), and the AUC were 0.98 (95% CI 0.97-0.99) and 0.99 (95% CI 0.97-0.99) in high TB burden and middle/low prevalence countries, respectively.

Conclusions: The diagnostic accuracy of Xpert MTB/RIF for rifampicin resistance detection was excellent.