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Table 4 shows the comparison of demographic and clinical characteristics between patients with positive and negative sputum acid-fast smear. We found that there was no significant factor of likelihood for negative sputum acid-fast smear from both univariate and multivariate analyses. Table 4 Demographic and clinical characteristics of 27 TB culture-proven patients with positive and negative sputum acid-fast smears. 4. Discussion A recent meta-analysis that included 9,557 participants from 27 studies showed that Xpert assay of respiratory specimens had a pooled sensitivity of 89% (95% CI 85%, 92%) and specificity of 99% (95% CI 98%-99%) in the diagnosis of pulmonary tuberculosis [13]. In our study that also used respiratory specimens, the overall sensitivity of Xpert assay was 95.3% and specificity was 86.4%, which were slightly higher and C646 clinical trial lower than those previous studies, respectively. Compared to conventional sputum acid-fast smear that had sensitivity of 60.5% and specificity of 98.5%, our study found that Xpert assay had statistically significant higher sensitivity (p value Chlormezanone with a small number of samples, also found a good concordant result with those studies; the sensitivity of Xpert assay to detect M. tuberculosis was 100% in acid-fast positive sputum specimens. This finding confirmed that it is unlikely for Xpert assay to miss the diagnosis of TB in patients with positive sputum acid-fast smear. However, our study showed that the sensitivity of Xpert assay for detection of M. tuberculosis in culture-proven AZD5363 datasheet TB specimens but negative acid-fast smear was 88.2%. Our study showed considerably higher sensitivity than those in previous studies that had a pooled sensitivity of 67% (95% CI 60%, 74%) with a range from 57.1 to 76.9% [13]. Our study also showed a 100% sensitivity of Xpert assay in detecting M. tuberculosis in subgroup of 29 HIV infected patients; this was higher than 84% and 69.6% in previous studies [14, 15]. The difference in sensitivity of Xpert assay on detection of M. tuberculosis among studies may be resulted from the difference in inclusion criteria. Inclusion of patients with minimal symptoms or normal chest X-ray that may have low bacillary load could result in higher rate of negative results from Xpert assay. In addition, the technique to obtain sputum specimens varied among studies. Sputum induction may cause less bacillary load compared to the expectorated sputum [12, 16]. Although WHO endorsed the wide use of Xpert MTB/RIF assay, this test is expensive and available only in large medical centers in Thailand.