Precisión diagnóstica de la secuenciación de genoma completo para la detección de resistencia a fármacos en Mycobacterium tuberculosis: Una revisión sistemática
Palabras clave:
Tuberculosis resistente a fármacos, Secuenciación de genoma completo, Precisión diagnóstica, Sensibilidad y especificidad, Revisión sistemáticaResumen
Antecedentes: La tuberculosis resistente a los medicamentos (DR-TB) es una crisis de salud pública. El estándar de referencia para su diagnóstico, la prueba de sensibilidad a fármacos (DST) fenotípica, es precisa, pero tarda de 6 a 8 semanas, retrasando el tratamiento. La Secuenciación de Genoma Completo (WGS) emerge como una alternativa rápida, pero su precisión en comparación con el estándar de referencia requiere una síntesis rigurosa de la evidencia primaria.
Objetivo: Evaluar la evidencia primaria disponible sobre la precisión diagnóstica de la WGS (prueba índice) en comparación con la DST fenotípica (prueba de referencia) para la detección de resistencia a fármacos en aislados clínicos de Mycobacterium tuberculosis.
Métodos: Se realizó una revisión sistemática siguiendo las guías PRISMA 2020 y QUADAS-2. Se ejecutaron búsquedas sistemáticas en PubMed/MEDLINE, Embase y LILACS sin restricciones. Los criterios de elegibilidad se centraron en estudios primarios de precisión diagnóstica. Los datos de sensibilidad y especificidad fueron extraídos y evaluados críticamente.
Resultados: La búsqueda identificó 20 registros. Tras el cribado, 19 fueron excluidos (la mayoría por ser revisiones secundarias). Un único estudio primario (Enkirch et al., 2020), que incluyó 1,248 aislados clínicos en Suecia, cumplió con los criterios. El estudio reportó una alta precisión diagnóstica: para Rifampicina, la sensibilidad fue del 100% y la especificidad del 99.5%; para Isoniazida, la sensibilidad fue del 93.5% y la especificidad del 100%. El riesgo de sesgo en el estudio incluido fue «no claro» en los dominios de cegamiento.
Conclusión: La evidencia primaria identificada, aunque limitada a un único estudio, corrobora la alta precisión de la WGS para la detección de resistencia. La discordancia genotipo-fenotipo, como la observada en mutaciones rpoB en disputa, y las barreras de implementación (costo y bioinformática) parecen ser desafíos más significativos que la precisión técnica de la prueba.
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Derechos de autor 2025 Monique Suzan Monteiro de Souza, Rafaela Vieira Mota, Gabriella Esper Cury de Araujo, Patricia Jazmín Martínez Gallardo, Rafael Corrêa de Souza, Maria Luján Britez, Nathalia do Rego Barros Araújo Vasconcelos, Júlia Beatriz Nunes da Silva, Gustavo Boostel Menezes de Assis, Rogério Ribeiro, Andrea Paola Britos Gómez (Autor/a)
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0.
