Research Article
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Evaluation of Drug Susceptibility Testing of Mycobacterium tuberculosis Isolates Against First Line Antituberculosis Drugs With a New Agar Medium

Year 2023, Volume: 37 Issue: 3, 82 - 88, 31.12.2023
https://doi.org/10.54962/ankemderg.1405334

Abstract

Tuberculosis (TB) is an infectious disease that is one of the leading causes of death among infectious diseases worldwide. According to the epidemiologic distribution of TB, most countries with a high proportion of patients infected with TB bacilli are middle and low income countries. Therefore, the study aimed to evaluate the effectiveness of AYC.2.2 agar medium, a new medium that can be easily used for drug susceptibility testing of TB and multidrug resistant. TB isolates, with clinical isolates in low income countries and laboratories. Mycobacterium tuberculosis ATCC 27294 (H37Rv, susceptible to all drugs), ATCC 35822 (isoniazid resistant), ATCC 35838 (rifampicin resistant), ATCC 35820 (streptomycin resistant), and ATCC 35837 (ethambutol resistant) reference strains and 34 clinical isolates were tested. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and concordance were calculated between the reference method and the agar proportion method using AYC 2.2 agar for all anti TB drugs and isolates in the study. For isoniazid and rifampicin, all values were 100%. For ethambutol, sensitivity was 100%, specificity 88.23%, PPV 89.47%, NPV 100%, and concordance %94. For streptomycin, sensitivity was 100%, specificity 77.77%, PPV 80%, NPV 100%, and concordance %88. M. tuberculosis ATCC strains were not included in the evaluation of clinical isolates, and the agreement was 100%. According to the results obtained, AYC.2.2. agar could be used as effectively as automated systems in determining susceptibility results, despite the disadvantage of growth time compared to broth automated systems. Its low cost and easy preparation are among its biggest advantages. However, further multicenter studies are needed before routine use.

References

  • CLSI Standards. Susceptibility Testing of Mycobacteria, Nocardiae, and Other Aerobic Actinomycetes; Approved Standard-Second Edition. CLSI document M24-A2. Wayne. PA: Clinical and Laboratory Standards Institute (2011).
  • Coban AY, Akgüneş A, Durupınar B. Mikobakterilerin Üretilmesinde Kanlı Agar Besiyerinin Değerlendirilmesi. Mikrobiyol Bul. 2011;45(4):617-22.
  • Coban AY. A novel agar base medium for drug susceptibility testing of Mycobacterium tuberculosis isolates. Future Microbiol. 2021;16:949-53. doi:10.2217/fmb-2021-0032
  • Coban AY, Ceyhan I, Uzun M, et al. Multicenter evaluation of AYC.2.2 agar for the isolation of mycobacteria from clinical samples. Indian J Med Microbiol. 2022;40(1):127-131. doi:10.1016/j.ijmmb.2021.12.002
  • Coban AY. Validation of a novel medium for drug susceptibility testing of Mycobacterium tuberculosis against first- and second-line drugs: AYC.2.2 Agar and AYC.2.1 broth. Int J Mycobacteriol. 2021;10(1):19-25. doi:10.4103/ijmy.ijmy_194_20
  • de Waard JH, Robledo J. Conventional diagnostic methods, pp: 401-24. In: Palomino JC, Leao SC, RitaccoV (eds), Tuberculosis (2007): From Basic Science to Patient Care. 2007, 1st ed. www.TuberculosisTextbook.com
  • Floyd K, Glaziou P, Zumla A, Raviglione M. The global tuberculosis epidemic and progress in care, prevention, and research: an overview in year 3 of the End TB era. Lancet Respir Med. 2018;6(4):299-314. doi:10.1016/S2213-2600(18)30057-2
  • Food and Drug Administration. Guidance for industry and FDA. Class II special controls guidance document: antimicrobial susceptibility test (AST) systems. Center for Devices and Radiological Health, Food and Drug Administration, U.S. Department of Health and Human Services, Silver Spring, MD (2009)
  • World Health Organization. The End TB Strategy. World Health Organization. Geneva, Switzerland (2015).
  • World Health Organization. Technical Manual for Drug Susceptibility Testing of Medicines Used in the Treatment of Tuberculosis. World Health Organization. Geneva, Switzerland (2018).
  • World Health Organization. Global tuberculosıs report. World Health Organization, Geneva, Switzerland (2020).
  • World Health Organization. Global tuberculosıs report. World Health Organization, Geneva, Switzerland (2021).

MYCOBACTERIUM TUBERCULOSIS İZOLATLARININ BİRİNCİ SEÇENEK ANTİ-TÜBERKÜLOZ İLAÇLARA DUYARLILIĞININ YENİ BİR AGAR BESİYERİ İLE TEST EDİLEREK DEĞERLENDİRİLMESİ

Year 2023, Volume: 37 Issue: 3, 82 - 88, 31.12.2023
https://doi.org/10.54962/ankemderg.1405334

Abstract

Tüberküloz (TB), dünya genelinde enfeksiyon kaynaklı hastalıklar arasında ölümün önde gelen nedenlerinden biri olan bulaşıcı bir hastalıktır. TB’nin epidemiyolojik dağılımına göre, yüksek oranda TB basili ile enfekte hastaların bulunduğu ülkelerin büyük bir bölümü orta ve düşük gelirli ülkelerdir. Bu nedenle çalışmada düşük gelirli ülkelerde ve laboratuvarlarda TB ve çok ilaca dirençli ( TB izolatlarının ilaç duyarlılık testleri için kolayca kullanılabilecek yeni bir besiyeri olan AYC.2.2 agar besiyerinin klinik izolatlarla etkinliğinin değerlendirilmesi amaçlanmıştır. Çalışmada Mycobacterium tuberculosis ATCC 27294 (H37Rv, tüm ilaçlara duyarlı), ATCC 35822 (izoniazid dirençli), ATCC 35838 (rifampisin dirençli), ATCC 35820 (streptomisin dirençli) ve ATCC 35837 (etambutol dirençli) referans suşlar ve 34 klinik izolat test edilmiştir. Çalışmadaki tüm anti TB ilaçlar ve izolatlar için kullanılan referans yöntem ve AYC.2.2 agar kullanılarak yapılan agar proporsiyon metodu arasında duyarlılık, özgüllük, pozitif prediktif değer (PPD), negatif prediktif değer (NPD) ve uyum hesaplanmıştır. İzoniazid ve rifampisin için tüm değerler %100 bulunmuştur. Etambutol için duyarlılık %100, özgüllük %88.23, PPD %89.47, NPD %100, uyum %94 olarak hesaplanmıştır. Streptomisin için duyarlılık %100, özgüllük %77.77, PPD %80, NPD %100, uyum %88 bulunmuştur. M. tuberculosis ATCC suşları klinik izolatların değerlendirilmesine dahil edilmemiş ve bunlardaki uyum %100 bulunmuştur. Elde edilen sonuçlara göre, sıvı otomatize sistemlere oranla üreme süresi dezavantaj olmasına rağmen, AYC.2.2. agar duyarlılık sonuçlarının belirlenmesinde otomatik sistemler kadar etkili bir şekilde kullanılabilmiştir. Maliyetinin düşük olması ve hazırlanmasının kolay olması en büyük avantajlarındandır. Ancak, rutin kullanıma geçmeden önce çok merkezli çalışmalara ihtiyaç vardır.

References

  • CLSI Standards. Susceptibility Testing of Mycobacteria, Nocardiae, and Other Aerobic Actinomycetes; Approved Standard-Second Edition. CLSI document M24-A2. Wayne. PA: Clinical and Laboratory Standards Institute (2011).
  • Coban AY, Akgüneş A, Durupınar B. Mikobakterilerin Üretilmesinde Kanlı Agar Besiyerinin Değerlendirilmesi. Mikrobiyol Bul. 2011;45(4):617-22.
  • Coban AY. A novel agar base medium for drug susceptibility testing of Mycobacterium tuberculosis isolates. Future Microbiol. 2021;16:949-53. doi:10.2217/fmb-2021-0032
  • Coban AY, Ceyhan I, Uzun M, et al. Multicenter evaluation of AYC.2.2 agar for the isolation of mycobacteria from clinical samples. Indian J Med Microbiol. 2022;40(1):127-131. doi:10.1016/j.ijmmb.2021.12.002
  • Coban AY. Validation of a novel medium for drug susceptibility testing of Mycobacterium tuberculosis against first- and second-line drugs: AYC.2.2 Agar and AYC.2.1 broth. Int J Mycobacteriol. 2021;10(1):19-25. doi:10.4103/ijmy.ijmy_194_20
  • de Waard JH, Robledo J. Conventional diagnostic methods, pp: 401-24. In: Palomino JC, Leao SC, RitaccoV (eds), Tuberculosis (2007): From Basic Science to Patient Care. 2007, 1st ed. www.TuberculosisTextbook.com
  • Floyd K, Glaziou P, Zumla A, Raviglione M. The global tuberculosis epidemic and progress in care, prevention, and research: an overview in year 3 of the End TB era. Lancet Respir Med. 2018;6(4):299-314. doi:10.1016/S2213-2600(18)30057-2
  • Food and Drug Administration. Guidance for industry and FDA. Class II special controls guidance document: antimicrobial susceptibility test (AST) systems. Center for Devices and Radiological Health, Food and Drug Administration, U.S. Department of Health and Human Services, Silver Spring, MD (2009)
  • World Health Organization. The End TB Strategy. World Health Organization. Geneva, Switzerland (2015).
  • World Health Organization. Technical Manual for Drug Susceptibility Testing of Medicines Used in the Treatment of Tuberculosis. World Health Organization. Geneva, Switzerland (2018).
  • World Health Organization. Global tuberculosıs report. World Health Organization, Geneva, Switzerland (2020).
  • World Health Organization. Global tuberculosıs report. World Health Organization, Geneva, Switzerland (2021).
There are 12 citations in total.

Details

Primary Language Turkish
Subjects Clinical Microbiology
Journal Section Research Articles
Authors

Pooya Salehı Moharer This is me 0000-0003-4048-0195

Kübra Yıldırım 0000-0003-0558-8619

Ahmet Yılmaz Çoban 0000-0002-8815-6063

Publication Date December 31, 2023
Submission Date November 1, 2023
Acceptance Date December 5, 2023
Published in Issue Year 2023 Volume: 37 Issue: 3

Cite

Vancouver Salehı Moharer P, Yıldırım K, Çoban AY. MYCOBACTERIUM TUBERCULOSIS İZOLATLARININ BİRİNCİ SEÇENEK ANTİ-TÜBERKÜLOZ İLAÇLARA DUYARLILIĞININ YENİ BİR AGAR BESİYERİ İLE TEST EDİLEREK DEĞERLENDİRİLMESİ. ANKEM Derg. 2023;37(3):82-8.

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