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JAC Advance Access originally published online on August 11, 2009
Journal of Antimicrobial Chemotherapy 2009 64(4):794-796; doi:10.1093/jac/dkp284
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© The Author 2009. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Original research

Rapid detection of resistant tuberculosis by nitrate reductase assay performed in three settings in Brazil

Maria de Lourdes Shikama1, Regina Ruivo Ferro E. Silva2, Maria Conceição Martins3, Carmen Maria Saraiva Giampaglia3,*, Rosângela Siqueira Oliveira3, Rosmari F. A. M. Silva1, Paula Ferro E. Silva2, Maria Alice da Silva Telles3, Anandi Martin4 and Juan Carlos Palomino4

1 Regional Laboratory Sorocaba, Brazil 2 Regional Laboratory Santo André, Brazil 3 Instituto Adolfo Lutz Mycobacteria Laboratory, São Paulo, Brazil 4 Mycobacteriology Unit, Institute of Tropical Medicine, Antwerpen, Belgium

Received 20 March 2009; returned 20 May 2009; revised 26 June 2009; accepted 13 July 2009

* Corresponding author. Mycobacteria Department, Instituto Adolfo Lutz, Av Dr. Arnaldo, 351 São Paulo, Brazil. Tel: +55 11 3068 2986; Fax: +55 11 3085 3505; E-mail: hrgiampa{at}uol.com.br

Objectives: To evaluate nitrate reductase assay (NRA) efficacy for streptomycin, isoniazid, rifampicin and ethambutol susceptibility testing of Mycobacterium tuberculosis strains.

Methods: Results were generated by three laboratories: the Instituto Adolfo Lutz (IAL) Mycobacteria Reference Laboratory and two IAL Regional Laboratories in Santo André and Sorocaba, São Paulo State, Brazil. One hundred and twenty M. tuberculosis strains were simultaneously tested using NRA and the proportion method (PM), while 117 strains were tested using both NRA and BACTEC MGIT 960 (M960).

Results: Repeatability analysis of NRA results showed rates of 100% for isoniazid and ethambutol and 97% for streptomycin and rifampicin susceptibility detection, representing substantial agreement. McNemar testing of the data also indicates that NRA and PM, as well as NRA and M960, do not differ significantly. On average, NRA results were available after 10 days.

Conclusions: The data demonstrate that NRA is reliable for susceptibility testing of isoniazid and rifampicin, the two most important drugs for the treatment of tuberculosis. In addition, the reduction in the time necessary to obtain susceptibility results is of fundamental importance.

Keywords: drug susceptibility testing , M. tuberculosis diagnostic , NRA , MGIT 960 , proportion method


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