Liquid vs Solid Culture Medium to Evaluate Proportion and Time to Change in Management of Suspects of Tuberculosis-A Pragmatic Randomized Trial in Secondary and Tertiary Health Care Units in Brazil

• Published in: PloS one 2015-06, Vol.10 (6), p.e0127588-e0127588
• Main Authors: Moreira, Adriana da Silva Rezende, Huf, Gisele, Vieira, Maria Armanda Monteiro da Silva, Costa, Paulo Albuquerque da, Aguiar, Fábio, Marsico, Anna Grazia, Fonseca, Leila de Souza, Ricks, Mônica, Oliveira, Martha Maria, Detjen, Anne, Fujiwara, Paula Isono, Squire, Stephen Bertel, Kritski, Afranio Lineu
• Format: Article
• Language: English
• Subjects: Acids; Adolescent; Adult; Antitubercular Agents - therapeutic use; Automation; Bacteriological Techniques; Brazil; Cerebrospinal fluid; Clinical trials; Comparative analysis; Data processing; Diagnosis; Female; Health care; HIV; Hospitals; Human immunodeficiency virus; Humans; Laboratories; Low income groups; Lung diseases; Male; Management; Medical diagnosis; Medical schools; Middle Aged; Motivation; Mycobacterium tuberculosis; Mycobacterium tuberculosis - isolation & purification; Patients; Randomization; Reagent Kits, Diagnostic; Secondary Care; Smear; Tertiary Healthcare; Tuberculosis; Tuberculosis - diagnosis; Tuberculosis - drug therapy; Tuberculosis - microbiology; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0127588

The use of liquid medium (MGIT960) for tuberculosis (TB) diagnosis was recommended by WHO in 2007. However, there has been no evaluation of its effectiveness on clinically important outcomes. A pragmatic trial was carried out in a tertiary hospital and a secondary health care unit in Rio de Janeiro City, Brazil. Participants were 16 years or older, suspected of having TB. They were excluded if only cerebral spinal fluid or blood specimens were available for analysis. MGIT960 technique was compared with the Lowenstein-Jensen (LJ) method for laboratory diagnosis of active TB. Primary outcome was the proportion of patients who had their initial medical management changed within 2 months after randomisation. Secondary outcomes were: mean time for changing the procedure, patient satisfaction with the overall treatment and adverse events. Data were analysed by intention-to-treat. Between April 2008 and September 2011, 693 patients were enrolled (348 to MGIT, 345 to LJ). Smear and culture results were positive for 10% and 15.7% of participants, respectively. Patients in the MGIT arm had their initial medical management changed more frequently than those in the LJ group (10.1% MGIT vs 3.8% LJ, RR 2.67 95% CI 1.44-.96, p = 0.002, NNT 16, 95% CI 10-39). Mean time for changing the initial procedure was greater in LJ group at both sites: 20.0 and 29.6 days in MGIT group and 52.2 and 64.3 in LJ group (MD 33.5, 95% CI 30.6-36.4, p = 0.0001). No other important differences were observed. This study suggests that opting for the MGIT960 system for TB diagnosis provides a promising case management model for improving the quality of care and control of TB. Controlled-Trials.com ISRCTN79888843.