Institute of Tropical Medicine Antwerp
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The nitrate reductase assay for the rapid detection of isoniazid and rifampicin resistance in Mycobacterium tuberculosis: a systematic review and meta-analysis

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dc.contributor.author Martin, A. en_US
dc.contributor.author Panaiotov, S. en_US
dc.contributor.author Portaels, F. en_US
dc.contributor.author Hoffner, S. en_US
dc.contributor.author Palomino, J. C. en_US
dc.contributor.author Angeby, K. en_US
dc.date.accessioned 2008-09-18T11:52:03Z
dc.date.available 2008-09-18T11:52:03Z
dc.date.issued 2008
dc.identifier.issn 0305-7453
dc.identifier.doi http://dx.doi.org/10.1093/jac/dkn139
dc.identifier.other ITG-M1A en_US
dc.identifier.other ITG-M3A en_US
dc.identifier.other ITG-M5A en_US
dc.identifier.other MICRO en_US
dc.identifier.other U-MYCOB en_US
dc.identifier.other JIF en_US
dc.identifier.other DOI en_US
dc.identifier.other UPD6 en_US
dc.identifier.other ABSTRACT en_US
dc.identifier.uri http://hdl.handle.net/10390/2374
dc.description.abstract Objectives: The reference standard methods for drug susceptibility testing (DST) of M. tuberculosis are very slow to give results, and due to the emergence of multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis, there is an urgent demand for new, rapid and accurate DST methods, particularly in low-income countries. The nitrate reductase assay (NRA) has been proposed as a rapid method for the detection of resistance to rifampicin and isoniazid, but its accuracy has not been systematically evaluated. Methods: We performed a systematic review and meta-analysis to evaluate the accuracy of the NRA for the detection of rifampicin- and isoniazid-resistant tuberculosis. We searched Medline PubMed (NCBI), Global Health-CAB, EJS-E (EbscoHost), ISI Web, Web of Science and IFCC and contacted authors if additional information was required. Fifteen studies met our inclusion criteria for rifampicin resistance detection and 13 for isoniazid. Of these, the majority of the studies used culture isolates on solid medium, four used culture isolates on liquid medium and three used sputum samples. We applied the summary receiver operating characteristic (SROC) curve to perform meta-analysis and to summarize diagnostic accuracy. Results: For rifampicin, the majority of the studies that applied NRA to isolates had a sensitivity and specificity >94% and for isoniazid, >92%. The three studies that applied NRA directly on sputum samples had a sensitivity and specificity that ranged between 88% and 100%. The SROC curve had an area of >0.99 for both drugs. Conclusions: There is evidence that NRA is highly sensitive and specific for the rapid detection of rifampicin and isoniazid resistance in culture isolates. More evidence is required for the NRA applied directly on sputum samples, but preliminary results appear promising and show a good sensitivity and specificity. Additional studies are required in countries with a high prevalence of MDR-TB and also cost-effectiveness analysis in order to obtain a complete picture on the utility of this method for rapid drug resistance detection in tuberculosis. en_US
dc.language English en_US
dc.subject Bacterial diseases en_US
dc.subject Tuberculosis en_US
dc.subject Mycobacterium tuberculosis en_US
dc.subject Isoniazid en_US
dc.subject Rifampicin en_US
dc.subject Drug sensitivity testing en_US
dc.subject Rapid assessment en_US
dc.subject Nitrate reductase assay en_US
dc.subject Systematic review en_US
dc.subject Meta-analysis en_US
dc.title The nitrate reductase assay for the rapid detection of isoniazid and rifampicin resistance in Mycobacterium tuberculosis: a systematic review and meta-analysis en_US
dc.type Article en_US
dc.citation.issue 1 en_US
dc.citation.jtitle Journal of Antimicrobial Chemotherapy en_US
dc.citation.volume 62 en_US
dc.citation.pages 56-64 en_US
dc.identifier.pmid http://www.ncbi.nlm.nih.gov/pubmed/18407918
dc.citation.jabbreviation J Antimicrob Chemother en_US


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