An assessment of nucleic acid amplification testing for active mycobacterial infection
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Van der Oest, Kelly & Hood (2004) New Zealand N=244 Patients with documented length of delay=152 (62%) |
Delay between development of symptoms and notification of the case |
Favourable treatment outcome OR: 1.02 (95%CI 0.99–1.04) p=0.15 |
CI = confidence interval; OR = odds ratio; ORadj = adjusted odds ratio; TST = tuberculin skin test
a Adjusted OR, determined from logistic regression
b Favourable treatment outcome as defined by the WHO: cure or treatment completed
c OR determined from logistic regression
In summary, 2 studies reported that a delay in time to diagnosis was significantly associated with an increased risk of transmission of infection among contacts. Although these results are not surprising, they reinforce the belief that quicker diagnosis of TB is of great benefit in reducing the spread of TB to close contacts of infected individuals. The lack of an effect on favourable treatment outcomes after earlier initiation of treatment found in a retrospective cohort study agrees with the findings of the 2 studies, providing direct evidence on the effect of including NAAT in clinical decision-making. Those 2 studies found that inclusion or exclusion of NAAT results had no effect on morbidity and mortality rates.
To what extent does treating patients who have rifampicin-resistant MTB infections with alternative treatments result in better health outcomes for the patient and their contacts?
The aim of this literature search was to determine the effectiveness of change in management due to rifampicin-resistance mutations being identified. This could impact mortality, time to symptom resolution, QoL, the length of the infectious period, or the number of contacts infected with TB. None of the articles found completely met the PICO criteria found in Table . However, 3 studies provided some evidence to answer part of the research question. The study profiles can be found in Table (Appendix ) and an overall summary of the body of evidence is presented in Table .
Table Body of evidence matrix for studies investigating the effect of change in management due to detection of drug resistant MTB
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