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Comparison of Molecular and Conventional Methods for Detection of Multidrug-Resistant Tuberculosis in the United Sta

Comparison of Molecular and Conventional Methods for Detection of Multidrug-Resistant Tuberculosis in the United States, 2009 to 2011. Mitchell A. Yakrus, MS, MPH. Microbiologist Laboratory Branch 16 th Annual Conference The Union-North American Region February 25, 2012.

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Comparison of Molecular and Conventional Methods for Detection of Multidrug-Resistant Tuberculosis in the United Sta

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  1. Comparison of Molecular and Conventional Methods for Detection of Multidrug-Resistant Tuberculosis in the United States, 2009 to 2011 Mitchell A. Yakrus, MS, MPH Microbiologist Laboratory Branch 16th Annual Conference The Union-North American Region February 25, 2012 National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of Tuberculosis Elimination

  2. Background • CDC’s DTBE Laboratory Branch provides a service for the molecular detection of drug resistance (MDDR) to rapidly identify multidrug-resistant isolates of Mycobacterium tuberculosis complex (MTBC) • DNA sequencing of 9 genetic loci associated with resistance to first and second-line drugs • Concurrently perform growth-based conventional drug susceptibility testing (DST) • Agar proportion for 12 first and second-line antituberculosis drugs • MGIT 960 for pyrazinamide • MTBC isolates must meet specific criteria before submission for MDDR

  3. MDDR Request/Approval MDDR Isolate Received Conventional DST Molecular Analysis Molecular Results (Interim Report) Molecular + Conventional DST Results (Final Report)

  4. Methods • Received 285 requests for MDDR testing from 43 public health laboratories from September 2009 to February 2011 • Analyzed agreement between molecular and conventional results for rifampin (RMP) and isoniazid (INH) • Examined submission criteria as indicated on request forms for possible association with resistance to RMP or INH • Isolate known to be multi-drug resistant (MDR) • Patient previously treated for tuberculosis (TB) • Patient from an area with a high rate of drug resistance (foreign born)

  5. Agreement Between Molecular and Conventional Testing

  6. Association of RMP or INH Resistance with Submission Criteria

  7. Summary • MDDR was highly concordant with drug resistance results from growth-based conventional testing • Detection of resistance to RMP or INH was not significantly associated with specific submission criteria with the exception of whether isolates were submitted as known MDR • Further analysis of the association of submission criteria with results is needed to optimize testing algorithms • Need to collect clinical outcome data for patients to measure impact of rapidly identifying drug resistance and discordant results

  8. Acknowledgements • Angela M. Starks , PhD, Team Lead, Laboratory Capacity • Beverly Metchock, Dr. P.H. , D(ABMM), Team Lead, Reference Team

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