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Spot sputum samples are at least as good as early morning samples for identifying Mycobacterium tuberculosis

Overview of attention for article published in BMC Medicine, October 2017
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  • Good Attention Score compared to outputs of the same age (68th percentile)
  • Average Attention Score compared to outputs of the same age and source

Mentioned by

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7 tweeters

Citations

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6 Dimensions

Readers on

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57 Mendeley
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Title
Spot sputum samples are at least as good as early morning samples for identifying Mycobacterium tuberculosis
Published in
BMC Medicine, October 2017
DOI 10.1186/s12916-017-0947-9
Pubmed ID
Authors

Michael E. Murphy, Patrick P. J. Phillips, Carl M. Mendel, Emily Bongard, Anna L. C. Bateson, Robert Hunt, Saraswathi Murthy, Kasha P. Singh, Michael Brown, Angela M. Crook, Andrew J. Nunn, Sarah K. Meredith, Marc Lipman, Timothy D. McHugh, Stephen H. Gillespie

Abstract

The use of early morning sputum samples (EMS) to diagnose tuberculosis (TB) can result in treatment delay given the need for the patient to return to the clinic with the EMS, increasing the chance of patients being lost during their diagnostic workup. However, there is little evidence to support the superiority of EMS over spot sputum samples. In this new analysis of the REMoxTB study, we compare the diagnostic accuracy of EMS with spot samples for identifying Mycobacterium tuberculosis pre- and post-treatment. Patients who were smear positive at screening were enrolled into the study. Paired sputum samples (one EMS and one spot) were collected at each trial visit pre- and post-treatment. Microscopy and culture on solid LJ and liquid MGIT media were performed on all samples; those missing corresponding paired results were excluded from the analyses. Data from 1115 pre- and 2995 post-treatment paired samples from 1931 patients enrolled in the REMoxTB study were analysed. Patients were recruited from South Africa (47%), East Africa (21%), India (20%), Asia (11%), and North America (1%); 70% were male, median age 31 years (IQR 24-41), 139 (7%) co-infected with HIV with a median CD4 cell count of 399 cells/μL (IQR 318-535). Pre-treatment spot samples had a higher yield of positive Ziehl-Neelsen smears (98% vs. 97%, P = 0.02) and LJ cultures (87% vs. 82%, P = 0.006) than EMS, but there was no difference for positivity by MGIT (93% vs. 95%, P = 0.18). Contaminated and false-positive MGIT were found more often with EMS rather than spot samples. Surprisingly, pre-treatment EMS had a higher smear grading and shorter time-to-positivity, by 1 day, than spot samples in MGIT culture (4.5 vs. 5.5 days, P < 0.001). There were no differences in time to positivity in pre-treatment LJ culture, or in post-treatment MGIT or LJ cultures. Comparing EMS and spot samples in those with unfavourable outcomes, there were no differences in smear or culture results, and positive results were not detected earlier in Kaplan-Meier analyses in either EMS or spot samples. Our data do not support the hypothesis that EMS samples are superior to spot sputum samples in a clinical trial of patients with smear positive pulmonary TB. Observed small differences in mycobacterial burden are of uncertain significance and EMS samples do not detect post-treatment positives any sooner than spot samples.

Twitter Demographics

The data shown below were collected from the profiles of 7 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 57 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 57 100%

Demographic breakdown

Readers by professional status Count As %
Student > Ph. D. Student 11 19%
Student > Master 10 18%
Student > Bachelor 9 16%
Researcher 8 14%
Student > Doctoral Student 3 5%
Other 10 18%
Unknown 6 11%
Readers by discipline Count As %
Medicine and Dentistry 22 39%
Immunology and Microbiology 6 11%
Social Sciences 5 9%
Nursing and Health Professions 5 9%
Agricultural and Biological Sciences 3 5%
Other 9 16%
Unknown 7 12%

Attention Score in Context

This research output has an Altmetric Attention Score of 5. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 04 February 2021.
All research outputs
#5,412,789
of 20,215,995 outputs
Outputs from BMC Medicine
#2,114
of 2,981 outputs
Outputs of similar age
#104,753
of 337,934 outputs
Outputs of similar age from BMC Medicine
#145
of 213 outputs
Altmetric has tracked 20,215,995 research outputs across all sources so far. This one has received more attention than most of these and is in the 72nd percentile.
So far Altmetric has tracked 2,981 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 39.3. This one is in the 28th percentile – i.e., 28% of its peers scored the same or lower than it.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 337,934 tracked outputs that were published within six weeks on either side of this one in any source. This one has gotten more attention than average, scoring higher than 68% of its contemporaries.
We're also able to compare this research output to 213 others from the same source and published within six weeks on either side of this one. This one is in the 30th percentile – i.e., 30% of its contemporaries scored the same or lower than it.