%0 Journal Article
%9 ACL : Articles dans des revues avec comité de lecture répertoriées par l'AERES
%A Jaganath, D.
%A Nabeta, P.
%A Nicol, M. P.
%A Castro, R.
%A Wambi, P.
%A Zar, H. J.
%A Workman, L.
%A Lodha, R.
%A Singh, U. B.
%A Bavdekar, A.
%A Sanghavi, S.
%A Trollip, A.
%A Mace, A.
%A Bonnet, Maryline
%A Lounnas, Manon
%A de Haas, P.
%A Tiemersma, E.
%A Alland, D.
%A Banada, P.
%A Cattamanchi, A.
%A Ruhwald, M.
%A Wobudeya, E.
%A Denkinger, C. M.
%T Stool processing methods for xpert ultra testing in childhood tuberculosis: a prospective, multicountry accuracy study
%D 2025
%L fdi:010094444
%G ENG
%J Clinical Infectious Diseases
%@ 1058-4838
%K child ; tuberculosis ; diagnostics ; stool ; Xpert Ultra
%M ISI:001541486900001
%P [9 ]
%R 10.1093/cid/ciaf289
%U https://www.documentation.ird.fr/hor/fdi:010094444
%> https://www.documentation.ird.fr/intranet/publi/2025-09/010094444.pdf
%V [Early access]
%W Horizon (IRD)
%X Background Centrifuge-free processing methods support stool Xpert Ultra testing for childhood tuberculosis, but data on their accuracy, acceptability, and usability are limited.Methods We conducted a prospective evaluation of stool Xpert Ultra in India, South Africa, and Uganda with 3 methods: the Stool Processing Kit (SPK), the Simple One-Step method (SOS), and the Optimized Sucrose Flotation method (OSF). Children <15 years old with presumptive tuberculosis underwent sputum testing with Xpert Ultra and culture. We compared the accuracy of each method against a microbiological reference standard (tuberculosis if Xpert Ultra or culture positive) and a composite reference standard (tuberculosis if confirmed or unconfirmed tuberculosis). We surveyed laboratory staff to assess the acceptability and usability of the methods.Results We included 607 children, with a median age of 3.5 years (interquartile range, 1.3-7 years); 15.5% were human immunodeficiency virus positive. Against the microbiological reference standard, the sensitivities of SPK, SOS, and OSF were 36.9% (95% confidence interval, 28.6%-45.8%), 38.6% (17.2%-51.0%), and 31.3% (20.2%-44.1%), respectively, and the specificities, 98.2% (96.4%-99.3%), 97.3% (93.7%-99.1%), and 97.1% (93.3%-99%). The methods were acceptable and usable, but SOS was reported as most feasible to implement in a peripheral facility. Across methods, sensitivities increased among children who were culture positive (range, 55.0%-77.3%) and were low (13%-16.7%) against the composite reference standard. Adding stool Xpert Ultra increased sensitivity from 0% (OSF) to 11.8% (SPK/SOS), compared with sputum alone.Conclusions Stool processing methods for Xpert Ultra were acceptable and usable and performed similarly, with highest sensitivity among children with culture-positive tuberculosis.
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