{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T05:50:57Z","timestamp":1790229057484,"version":"4.1.0"},"reference-count":29,"publisher":"European Respiratory Society (ERS)","issue":"2","license":[{"start":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T00:00:00Z","timestamp":1757548800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001713","name":"European and Developing Countries Clinical Trials Partnership","doi-asserted-by":"publisher","award":["EDCTP2, DRIA2014-326 \u2014 DIAMA RIA Diagnostics"],"award-info":[{"award-number":["EDCTP2, DRIA2014-326 \u2014 DIAMA RIA Diagnostics"]}],"id":[{"id":"10.13039\/501100001713","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Foundation for Innovative Diagnostics"}],"content-domain":{"domain":["publications.ersnet.org"],"crossmark-restriction":true},"short-container-title":["ERJ Open Res"],"accepted":{"date-parts":[[2025,8,20]]},"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The World Health Organization-endorsed Xpert MTB\/XDR assay provides a rapid method to detect resistance to isoniazid, fluoroquinolones, injectables aminoglycosides and ethionamide, yet evaluation of its performance, particularly in endemic settings, remains limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a prospective multicentre study (June 2017 to March 2021) in nine sub-Saharan African countries, enrolling adults with pulmonary tuberculosis confirmed by Xpert MTB\/RIF or Ultra. Xpert MTB\/XDR results were compared to a World Health Organization-endorsed targeted next-generation sequencing reference used on the same sputum, with discordance resolved using whole genome sequencing and phenotypic drug-susceptibility testing when available. Diagnostic accuracy for each drug was calculated, also accounting for genotypic heteroresistance detection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 1238 included patients, Xpert MTB\/XDR demonstrated high specificity (\u226598%) across all drugs yet showed variable sensitivity, detecting 606 out of 637 isoniazid-resistant (95%, 95% CI 94\u201397%), 22 out of 33 fluoroquinolones-resistant (67%, 95% CI 48\u201381%) and 159 out of 279 ethionamide-resistant (57%, 95% CI 51\u201363%) samples. The assay reliably detected most common resistance-conferring mutations, such as\n                      <jats:italic>katG<\/jats:italic>\n                      _S315T,\n                      <jats:italic>fabG1<\/jats:italic>\n                      _C-15T, and\n                      <jats:italic>gyrA<\/jats:italic>\n                      _A90V and D94G, yet failed to detect low-frequency heteroresistance (\u226410\u201335%) and off-target mutations, mostly for ethionamide. Amikacin resistance was rare (0.2%). Sensitivity for fluoroquinolones was higher (78%) among rifampicin-resistant samples, highlighting its utility as a reflex test in rifampicin-resistant patients.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Xpert MTB\/XDR offers rapid diagnosis of resistance with high specificity. While limitations in detecting low-frequency and off-target variants affect its sensitivity, most frequent, fixed in-target mutations are readily detected. Future studies should evaluate strategies to integrate Xpert MTB\/XDR with other diagnostic approaches in national tuberculosis programmes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1183\/23120541.00427-2025","type":"journal-article","created":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T16:55:22Z","timestamp":1757609722000},"page":"00427-2025","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Multicentre field evaluation of Xpert MTB\/XDR in sub-Saharan Africa"],"prefix":"10.1183","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3045-3778","authenticated-orcid":false,"given":"Faridath","family":"Massou","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bassirou","family":"Diarra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Awa","family":"Ba Diallo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kindy Sadio","family":"Bah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7253-638X","authenticated-orcid":false,"given":"Comfort","family":"Vuchas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Neh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa","family":"Sander","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel O.","family":"Adebiyi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bolaji Olufemi","family":"Aderemi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Schadrac C.","family":"Agbla","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sian","family":"Floyd","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michel K.","family":"Kaswa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muriel","family":"Aloni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Musala","family":"Sissy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bertin","family":"Ushizimpumu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esdras Belamo","family":"Niyigena","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6075-5603","authenticated-orcid":false,"given":"J.C.S.","family":"Ngabonziza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7172-9136","authenticated-orcid":false,"given":"Gemeda","family":"Abebe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mulualem","family":"Tadesse","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boubacar","family":"Bah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lansana","family":"Camara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aissatou","family":"Gaye Diallo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Makhtar","family":"Camara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatimata","family":"Diallo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anti\u00e8m\u00e9 Combo Georges","family":"Togo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Ferr\u00e9","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1994-5894","authenticated-orcid":false,"given":"Nelly","family":"Badalato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Penn-Nicholson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel G.","family":"Schumacher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sourou Toussaint","family":"Odjougbele","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabine","family":"Houeto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wim","family":"Mulders","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krista","family":"Frissette","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wakjira","family":"Kebede","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osman","family":"El Tayeb","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corinne S","family":"Merle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1017-4675","authenticated-orcid":false,"given":"Bouke Catherine","family":"de Jong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip","family":"Supply","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dissou","family":"Affolabi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leen","family":"Rigouts","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"81","published-online":{"date-parts":[[2025,9,11]]},"reference":[{"key":"2026050510151477000_12.2.00427-2025.1","unstructured":"World Health Organization (WHO) . WHO Consolidated Guidelines on Tuberculosis. Module 4: Treatment and Care. Geneva, WHO, 2025."},{"key":"2026050510151477000_12.2.00427-2025.2","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/S2213-2600(23)00389-2","article-title":"Short oral regimens for pulmonary rifampicin-resistant tuberculosis (TB-PRACTECAL): an open-label, randomised, controlled, phase 2B-3, multi-arm, multicentre, non-inferiority trial","volume":"12","author":"Nyang'wa","year":"2024","journal-title":"Lancet Respir Med"},{"key":"2026050510151477000_12.2.00427-2025.3","unstructured":"World Health Organization (WHO) . Module 3: Diagnosis WHO Consolidated Guidelines on Tuberculosis. Geneva, WHO, 2025."},{"key":"2026050510151477000_12.2.00427-2025.4","first-page":"145","article-title":"Current tools available for the diagnosis of drug-resistant tuberculosis","volume":"3","author":"Gilpin","year":"2016","journal-title":"Ther Adv Infect Dis"},{"key":"2026050510151477000_12.2.00427-2025.5","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD014841.pub2"},{"key":"2026050510151477000_12.2.00427-2025.6","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.02338-2020"},{"key":"2026050510151477000_12.2.00427-2025.7","unstructured":"World Health Organization (WHO) . Catalogue of Mutations in Mycobacterium tuberculosis Complex and Their Association With Drug Resistance, 2nd ed. Geneva, WHO, 2023."},{"key":"2026050510151477000_12.2.00427-2025.8","unstructured":"World Health Organization (WHO) . Technical Report on Critical Concentrations for Drug Susceptibility Testing of Medicines Used in the Treatment of Drug-Resistant Tuberculosis. Geneva, WHO, 2018."},{"key":"2026050510151477000_12.2.00427-2025.9","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-018-21378-x"},{"key":"2026050510151477000_12.2.00427-2025.10","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(21)00452-7"},{"key":"2026050510151477000_12.2.00427-2025.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2008.08.010"},{"key":"2026050510151477000_12.2.00427-2025.12","doi-asserted-by":"publisher","DOI":"10.1126\/science.272.5268.1641"},{"key":"2026050510151477000_12.2.00427-2025.13","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1002\/biof.5520100219","article-title":"AhpC, oxidative stress and drug resistance in Mycobacterium tuberculosis","volume":"10","author":"Sherman","year":"1999","journal-title":"BioFactors"},{"key":"2026050510151477000_12.2.00427-2025.14","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1038\/s41598-023-27516-4","article-title":"Large-scale genomic analysis of Mycobacterium tuberculosis reveals extent of target and compensatory mutations linked to multi-drug-resistant tuberculosis","volume":"13","author":"Napier","year":"2023","journal-title":"Sci Rep"},{"key":"2026050510151477000_12.2.00427-2025.15","doi-asserted-by":"publisher","DOI":"10.1378\/chest.14-1286"},{"key":"2026050510151477000_12.2.00427-2025.16","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.06272-11"},{"key":"2026050510151477000_12.2.00427-2025.17","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.02226-20"},{"key":"2026050510151477000_12.2.00427-2025.18","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1016\/j.jinf.2019.10.006","article-title":"Antibiotic resistance of Mycobacterium tuberculosis complex in Africa: a systematic review of current reports of molecular epidemiology, mechanisms and diagnostics","volume":"79","author":"Osei Sekyere","year":"2019","journal-title":"J Infect"},{"key":"2026050510151477000_12.2.00427-2025.19","unstructured":"World Health Organization (WHO) . Target Product Profile for Next-Generation Drug-susceptibility Testing at Peripheral Centres. Geneva, WHO, 2021."},{"key":"2026050510151477000_12.2.00427-2025.20","doi-asserted-by":"crossref","first-page":"e0022924","DOI":"10.1128\/jcm.00229-24","article-title":"Performance evaluation of the Xpert MTB\/XDR test for the detection of drug resistance to Mycobacterium tuberculosis among people diagnosed with tuberculosis in South Africa","volume":"62","author":"Omar","year":"2024","journal-title":"J Clin Microbiol"},{"key":"2026050510151477000_12.2.00427-2025.21","doi-asserted-by":"crossref","first-page":"e0183222","DOI":"10.1128\/jcm.01832-22","article-title":"Rapid detection of extensive drug resistance by Xpert MTB\/XDR optimizes therapeutic decision-making in rifampin-resistant tuberculosis patients","volume":"61","author":"Chen","year":"2023","journal-title":"J Clin Microbiol"},{"key":"2026050510151477000_12.2.00427-2025.22","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1016\/j.chembiol.2023.12.007","article-title":"Discovery of dual-active ethionamide boosters inhibiting the Mycobacterium tuberculosis ESX-1 secretion system","volume":"31","author":"Gries","year":"2024","journal-title":"Cell Chem Biol"},{"key":"2026050510151477000_12.2.00427-2025.23","first-page":"S1","article-title":"Accuracy in detecting fluoroquinolone-heteroresistant M. tuberculosis mixtures by Xpert MTB\/XDR.","volume":"28","author":"Dippenaar","year":"2024","journal-title":"Int J Tuberc Lung Dis"},{"key":"2026050510151477000_12.2.00427-2025.24","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-019-48289-9"},{"key":"2026050510151477000_12.2.00427-2025.25","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00664-16"},{"key":"2026050510151477000_12.2.00427-2025.26","doi-asserted-by":"publisher","DOI":"10.1186\/s12941-021-00478-z"},{"key":"2026050510151477000_12.2.00427-2025.27","doi-asserted-by":"publisher","DOI":"10.5588\/ijtld.17.0660"},{"key":"2026050510151477000_12.2.00427-2025.28","doi-asserted-by":"crossref","first-page":"7114","DOI":"10.1038\/s41467-024-51266-0","article-title":"Genetic diversity within diagnostic sputum samples is mirrored in the culture of Mycobacterium tuberculosis across different settings","volume":"15","author":"Mariner-Llicer","year":"2024","journal-title":"Nat Commun"},{"key":"2026050510151477000_12.2.00427-2025.29","doi-asserted-by":"crossref","first-page":"791","DOI":"10.5588\/ijtld.21.0428","article-title":"Guidance is needed to mitigate the consequences of analytic errors during antimicrobial susceptibility testing for TB","volume":"10","author":"K\u00f6ser","year":"2021","journal-title":"Int J Tuberc Lung Dis"}],"container-title":["ERJ Open Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1183\/23120541.00427-2025","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T17:15:40Z","timestamp":1778001340000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.ersnet.org\/lookup\/doi\/10.1183\/23120541.00427-2025"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,11]]},"references-count":29,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,3,9]]},"published-print":{"date-parts":[[2026,3]]}},"alternative-id":["10.1183\/23120541.00427-2025"],"URL":"https:\/\/doi.org\/10.1183\/23120541.00427-2025","relation":{},"ISSN":["2312-0541"],"issn-type":[{"value":"2312-0541","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,11]]}}}