Page 206 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 10 of 10 Original Research

TABLE 1-A1 (Continues...): Patients with positive urine Xpert rifampicin resistant results – details of additional tuberculosis tests and clinical course.
Study ID n Sample type Test Organism Susceptibility Susceptibility 12-week Classification Heteroresistance Reason for classification
to rifampicin to isoniazid outcome of urine Xpert
rifampicin
resistance†
JTBS160 1 Blood Culture Neg - - Alive False Resistance No Two cultures showed rifampicin
2 Sputum Culture MTB Sensitive Sensitive (on two results) sensitivity and patient improved
on drug-sensitive TB treatment.
1 Urine Culture Neg - -
JTBS181 1 Urine Xpert MTB Resistant - Alive True Resistance No Two culture results confirmed
2 Blood Culture Neg - - (on two results) rifampicin resistance.
1 Sputum Culture MTB Resistant -
2 Ascites Culture Neg - -
1 Urine Culture MTB Resistant Resistant
JTBS192 1 Sputum Culture MTB Resistant - Died True Resistance No Three culture results confirmed
1 Urine Xpert Neg - - rifampicin resistance.
1 Urine Culture MTB Resistant Resistant
1 Sputum Culture MTB Resistant Resistant
1 Sputum Culture Contam - -
1 Sputum Culture Neg - -
JTBS202 1 Urine Xpert Neg - - Alive False Resistance No One culture result showed
1 Blood Culture Neg - - rifampicin sensitivity and patient
improved on drug-sensitive TB
1 Sputum Culture Neg - - treatment
1 Sputum Culture MTB Sensitive Sensitive
JTBS211 9 Sputum Culture Neg - - Alive False Resistance No No confirmation of rifampicin
1 Sputum Culture Contam - - resistance patient improved on
drug-sensitive TB treatment.
JTBS249 1 Urine Xpert Neg - - Alive False Resistance No No confirmation of rifampicin
1 Blood Xpert Neg - - resistance and patient improved
on drug-sensitive TB treatment.
5 CSF Culture Neg
JTBS358 1 Urine Xpert MTB Sensitive - Alive False Resistance No No cultures confirmed rifampicin
1 Urine Xpert Neg - - resistance and patient improved
on drug-sensitive TB treatment.
1 Sputum Culture MTB - -
1 Blood Culture Neg - -
JTBS463 1 Urine Xpert MTB Resistant - Died True Resistance Yes Two urine Xpert results showed
1 Abscess Culture MTB Sensitive Sensitive (from two rifampicin resistance, but one
results)
abscess culture and one sputum
Xpert (2 months prior) showed
rifampicin sensitivity. Patient
started on drug-sensitive TB
treatment. About 1 month after
starting TB treatment the patient
was admitted for TB IRIS and
anaemia. Patient was then
readmitted shortly thereafter
with gastroenteritis and was
deteriorating despite drug-
sensitive TB treatment; it was at
this time two urine Xpert results
showed rifampicin resistance;
however the patient died shortly
after receipt of urine Xpert
results.
JTBS534 1 Urine Xpert Neg - - Died True Resistance No No samples confirmed rifampicin
1 Blood Culture Neg - - resistance. Patient presented with
ascites and pleural fluid of which
1 Ascites Culture Neg - - all TB tests were negative. Ascitic
1 Pleural Culture Neg - - fluid had high ADA and patient
was started on drug-sensitive TB
1 Sputum Culture Neg - - treatment. About 4 weeks later,
the patient was readmitted while
clinically deteriorating on
drug-sensitive TB treatment. A
urine Xpert result showed
rifampicin resistance; however,
the patient died shortly after
receipt of urine Xpert result.
JTBS574 1 Urine Xpert Neg - - Alive False Resistance No One culture and two Xpert results
1 Blood Culture Neg - - showed rifampicin sensitivity and
patient improved on drug-
1 Sputum Culture MTB Sensitive Sensitive sensitive TB treatment.
2 Sputum Xpert MTB Sensitive -
n = number of samples; – Susceptibility unknown or not available. Neg, negative; Contam, Contaminated; MTB, Mycobacterial tuberculosis; LTFU, lost to follow-up; TB, tuberculosis; Pleural, Pleural
effusion; Abscess, Abscess aspirate; Drug-sensitive TB treatment = Intensive phase with isoniazid, rifampicin, ethambutol and pyrazinamide, followed by consolidation phase with isoniazid and
rifampicin.
†, Two patients had false urine Xpert rifampicin resistance due to contamination (accounting for three results). These patients were excluded from analysis.
For JTBS patients, nearly all had their urine specimens tested by Xpert using two different methods (unconcentrated and concentrated). This accounts for why patients may have two urine Xpert
results. However, in the table above, rifampicin resistance was only detected on one urine Xpert result, unless stated otherwise. Some patients may have had an additional urine Xpert performed
for confirmation after receiving a rifampicin resistant result.
Of note, the table includes all other TB cultures and Xperts conducted on all clinical specimens, including repeat urine Xpert tests conducted.
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