The impact on airborne isolation duration utilizing GeneXpert versus acid-fast bacilli smears to guide discontinuation among individuals with suspected pulmonary tuberculosis: a systematic review and meta-analysis

OBJECTIVE: The GeneXpert® MTB/RIF nucleic acid amplification test has been proposed as an alternative method to smear microscopy in guiding de-isolation for patients with suspected pulmonary tuberculosis, given its convenience and higher diagnostic accuracy. Currently, there is no comprehensive review summarizing the evidence on the isolation duration using GeneXpert. This systematic review and meta-analysis addressed the length of airborne infection isolation in hospitalized patients initially suspected of having pulmonary tuberculosis where de-isolation decisions were guided by GeneXpert nucleic acid amplification test compared to traditional smear microscopy. METHODS: We conducted a comprehensive search in databases (Medline, Embase, and Scopus) from January 1, 2001, to April 1, 2026, and applied median-based quantile estimation methods to determine the pooled difference in median times of isolation. We also assessed diagnostic accuracy as well as hospital length of stay as secondary outcomes. RESULTS: We screened 746 titles and abstracts, of which 7 were eligible for inclusion. Five studies included in the meta-analysis involved 1,409 patients, all within low-incidence tuberculosis settings. The meta-analysis demonstrated that use of a single unconcentrated GeneXpert versus serial acid-fast bacilli smear microscopy resulted in a pooled reduction in median isolation duration by 38.8 hours (95% confidence interval 20.2-57.3 hours). CONCLUSION: Compared to serial microscopy, GeneXpert done on a single unconcentrated respiratory specimen reduces airborne infection isolation duration by over 1.5 days, on average, making it an attractive strategy for optimizing healthcare facility resources while evaluating persons for pulmonary tuberculosis.Protocol Registration (PROSPERO, CRD42024538644).