13 research outputs found
Water Supply Interruptions and Suspected Cholera Incidence: A Time-Series Regression in the Democratic Republic of the Congo
Data that underpins a publication on water supply interruptions and suspected Cholera incidenc
Recommended from our members
Xpert mycobacterium tuberculosis/rifampicin-detected rifampicin resistance is a suboptimal surrogate for multidrug-resistant tuberculosis in Eastern Democratic Republic of the Congo : diagnostic and clinical implications
CITATION: Bisimwa, B. C. et al. 2020. Xpert Mycobacterium tuberculosis/Rifampicin–Detected Rifampicin Resistance is a Suboptimal Surrogate for Multidrug-resistant Tuberculosis in Eastern Democratic Republic of the Congo: Diagnostic and Clinical Implications. Clinical Infectious Diseases, 73(2):e362–e370. doi:10.1093/cid/ciaa873The original publication is available at https://academic.oup.com/cid/Background
Rifampicin (RIF) resistance is highly correlated with isoniazid (INH) resistance and used as proxy for multidrug-resistant tuberculosis (MDR-TB). Using MTBDRplus as a comparator, we evaluated the predictive value of Xpert MTB/RIF (Xpert)–detected RIF resistance for MDR-TB in eastern Democratic Republic of the Congo (DRC).
Methods
We conducted a cross-sectional study involving data from new or retreatment pulmonary adult TB cases evaluated between July 2013 and December 2016. Separate, paired sputa for smear microscopy and MTBDRplus were collected. Xpert testing was performed subject to the availability of Xpert cartridges on sample remnants after microscopy.
Results
Among 353 patients, 193 (54.7%) were previously treated and 224 (63.5%) were MTBDRplus TB positive. Of the 224, 43 (19.2%) were RIF monoresistant, 11 (4.9%) were INH monoresistant, 53 (23.7%) had MDR-TB, and 117 (52.2%) were RIF and INH susceptible. Overall, among the 96 samples detected by MTBDRplus as RIF resistant, 53 (55.2%) had MDR-TB. Xpert testing was performed in 179 (50.7%) specimens; among these, 163 (91.1%) were TB positive and 73 (44.8%) RIF resistant. Only 45/73 (61.6%) Xpert-identified RIF-resistant isolates had concomitant MTBDRplus-detected INH resistance. Xpert had a sensitivity of 100.0% (95% CI, 92.1–100.0) for detecting RIF resistance but a positive-predictive value of only 61.6% (95% CI, 49.5–72.8) for MDR-TB. The most frequent mutations associated with RIF and INH resistance were S531L and S315T1, respectively.
Conclusions
In this high-risk MDR-TB study population, Xpert had low positive-predictive value for the presence of MDR-TB. Comprehensive resistance testing for both INH and RIF should be performed in this setting.https://academic.oup.com/cid/article/73/2/e362/5863452?login=truePublishers versio
Association of absence of water supply (0 m<sup>3</sup> of water supplied at day 0) with suspected cholera incidence on the 12 following days.
<p>Shaded area: 95% CI of RR.</p
Predicted incidence rate of suspected cholera for 10,000 as a function of water volume supplied, stratified by neighbourhoods with higher (≥2.8 l per person per day) and lower (<2.8 l per person per day) tap water consumption.
<p>Model covariates for this prediction were set to the dataset mid-point (September 1, 2011), median precipitation rate value (0.4 mm/h), median number of suspected cholera cases admitted in the other neighbourhood (1 case), and a Thursday.</p
Twelve-day cumulative association of volume of tap water supplied with suspected cholera incidence in Uvira.
<p>Shaded area: 95% CI for relative risk (RR)–model predictors: daily volume of water supplied, cubic spline of date, day of the week, precipitation rate of the day and number of CTC admissions on the previous 12 d.</p
Daily time series between January 1, 2009, and April 30, 2014, for admissions at the CTC, volume of water supplied, level of residual chlorine in produced water and precipitation rate in Uvira, DRC.
<p>Daily time series between January 1, 2009, and April 30, 2014, for admissions at the CTC, volume of water supplied, level of residual chlorine in produced water and precipitation rate in Uvira, DRC.</p
Distribution of admissions to CTC, volume of tap water supplied, and levels of residual chlorine in the water between January 1, 2009, and April 30, 2014, in Uvira, DRC.
<p>Distribution of admissions to CTC, volume of tap water supplied, and levels of residual chlorine in the water between January 1, 2009, and April 30, 2014, in Uvira, DRC.</p
Sensitivity analysis of the effect of the number of df/year in cubic spline of date and lag-response function on the 12-day cumulative association of volume supplied with admissions to CTC.
<p>Sensitivity analysis of the effect of the number of df/year in cubic spline of date and lag-response function on the 12-day cumulative association of volume supplied with admissions to CTC.</p
Mean incidence of suspected cholera at lag 6 d by quintile of volume of water supplied at lag 0 day.
<p>n: number of days.</p