Nitrate reductase assay for rapid detection of isoniazid, rifampin, ethambutol, and streptomycin resistance in Mycobacterium tuberculosis: a systematic review and meta-analysis

Colorimetric phenotypic tests recently gained interest because traditional primary drug susceptibility testing of Mycobacterium tuberculosis isolates takes a long time. We used meta-analysis techniques to review the reliability and accuracy of the nitrate reductase assay (NRA), which is one of the most popular colorimetric methods to detect resistance to first-line drugs. Medline, PubMed, ISI Web, Web of Science, and Google Scholar were used to search for studies enrolled in the meta-analysis. The analysis included 35 studies for isoniazid (INH), 38 for rifampin (RIF), and 22 for ethambutol (EMB) and streptomycin (STR). Summary receiver operating characteristic (SROC) curves were applied to summarize diagnostic accuracy. The meta-analyses were performed by the use of Meta-DiSc software (version 1.4) and were focused on sensitivity and specificity values for measurements of accuracy. The pooled sensitivities were 96% for INH, 97% for RIF, 90% for EMB, and 82% for STR. The pooled specificities for INH, RIF, EMB, and STR were 99%, 100%, 98%, and 96%, respectively. The times required to obtain results were between 5 and 28 days by the direct NRA and between 5 and 14 days by the indirect test. In conclusion, the present meta-analysis showed that the NRA is a reliable low-cost rapid colorimetric susceptibility test that can be used for the detection of multidrug-resistant (MDR) tuberculosis, including detection of EMB resistance. However, the test appears to have a relatively low sensitivity for STR and needs further improvement

Resazurin microtiter assay for isoniazid, rifampicin, ethambutol and streptomycin resistance detection in Mycobacterium tuberculosis: Updated metaanalysis

Aims: The present meta-analysis aims to assess the evidence regarding the diagnostic accuracy and performance characteristics of the colorimetric redox indicator (CRI) assay with a special emphasis on the use of the resazurin microtiter assay (REMA) for determination of primary anti-tuberculosis drug resistance. Subject and methods: By updating previous literature searches in Medline PubMed, ISI Web, Web of Science and Google academic databases of the REMA test for determination of primary anti-tuberculosis drug resistance, this meta-analysis includes 14 studies for isoniazid (INH); 15 studies for rifampicin (RIF); 6 studies for streptomycin (STR); and 5 studies for ethambutol (EMB). SROC curve analysis was performed for meta-analysis and diagnostic accuracy was summarized. Results: Pooled sensitivity was 96% (94–98%) for INH, 97% (95–98%) for RIF, 92% (87–96%) for EMB and 92% (88–95%) for STR. Pooled specificity for INH, RIF, EMB and STR was 96% (95–98%), 99% (98–99%), 86% (81–89%) and 90% (87–93%), respectively. Susceptibility testing results had been obtained in 8–9days. Conclusion: In conclusion, REMA seems to be a reliable test for the determination of multi-drug resistant (MDR) isolates in laboratories with limited resources. However, few studies for STR and EMB have been found, and cost-effectiveness studies need to be determined to recommend its widespread use

Use of Catheters for Vascular Access among Hemodialysis Patients: A Single Center's Experience

AIM: Vascular access is of prime importance for patients on hemodialysis. Most of the unplanned hemodialysis sessions are performed via venous catheters in our country. In the present study, we aimed to study early complications of placement of temporary or permanent hemodialysis catheters to patients with acute and/or chronic renal failure

Use of Catheters for Vascular Access among Hemodialysis Patients: A Single Center's Experience

AIM: Vascular access is of prime importance for patients on hemodialysis. Most of the unplanned hemodialysis sessions are performed via venous catheters in our country. In the present study, we aimed to study early complications of placement of temporary or permanent hemodialysis catheters to patients with acute and/or chronic renal failure