Diagnostic test of rifampicin resistance in Mycobacterium tuberculosis: a meta-analysis.

OBJECTIVE To evaluate available evidence on the diagnostic value of radioactivity-free cultivation and detection technologies for rapid detection of rifampicin resistance in Mycobacterium tuberculosis. METHODS A fully recursive literature search was conducted in PubMed, EMBASE, Biosis, Web of Science (all 1990-2010), CBMWeb (1978-2010), and Google Scholar. QUADAS items were used to evaluate the quality of included studies. Sensitivity, specificity, Summary receiver-operating curve SEN, SPE, SROC, and related techniques were used to assess the diagnostic value of radioactivity-free Mycobacterium tuberculosis cultivation and detection technologies. RESULTS Six studies were included in the final analysis. The MB/BacT, BACTEC MGIT 960, and Manual MGIT systems were highly sensitive and specific for detecting rifampicin-resistant TB. The summary SEN and summary SPE of the MB/BacT and BACTEC MGIT 960 systems were 100%, 99%, 100%, and 96%, respectively. The SROC of the BACTEC MGIT 960 system was 0.9943. CONCLUSION We recommended that the BACTEC 460 system be replaced by MB/BacT or BACTEC MGIT 960 as the final diagnostic test for rifampicin resistance in Mycobacterium tuberculosis. More studies are needed on the diagnostic value of other radioactivity-free cultivation and detection technologies to reliably determine their sensitivity and specificity for this bacterium.