Sputum microscopy and Xpert MTB/RIF are the primary rapid diagnostic methods for tuberculosis (TB) in Nepal. Disagreements among Xpert, microscopy, and culture, for example, cases with Xpert positive and microscopy negative, were frequently observed in Nepal including in our reference laboratory. The objective of this study was to compare the effectiveness of Xpert with culture and microscopy for TB diagnosis in Nepal. A total of 125 TB suspected sputum samples were processed for Xpert, microscopy, and culture. The Xpert results when compared with culture showed 100% sensitivity and 97.4% specificity with an excellent agreement (kappa = 0.96), whereas microscopy showed the sensitivity and specificity of 43.2% and 98.7%, respectively, with a moderate agreement (kappa = 0.4). The sensitivity and specificity of microscopy, when compared with Xpert, were 43.5% and 100%, respectively. The majority of Xpert positive samples of a medium MTB detection and all samples of low and very low MTB detection were missed by microscopy. Our study showed that Xpert MTB/RIF is a reliable tool for the diagnosis and management of TB in Nepal. Because of its high cost and sustainability, alternative simple and rapid diagnostic methods with a similar efficiency would be helpful for TB control in Nepal.

痰显微镜检查和 Xpert MTB/RIF 是尼泊尔结核病 (TB) 的主要快速诊断方法。Xpert、显微镜和培养之间的分歧，例如，Xpert 阳性和显微镜阴性的病例，在尼泊尔经常观察到，包括在我们的参考实验室。本研究的目的是比较 Xpert 与培养和显微镜检查对尼泊尔结核病诊断的有效性。总共处理了 125 份 TB 疑似痰液样本进行 Xpert、显微镜检查和培养。与培养相比，Xpert 结果显示 100% 的灵敏度和 97.4% 的特异性，具有极佳的一致性（kappa = 0.96），而显微镜检查的敏感性和特异性分别为 43.2% 和 98.7%，具有中等一致性（kappa = 0.4） . 与 Xpert 相比，显微镜的灵敏度和特异性，分别为 43.5% 和 100%。中 MTB 检测的大多数 Xpert 阳性样本以及所有低和极低 MTB 检测的样本都被显微镜检查遗漏了。我们的研究表明，Xpert MTB/RIF 是尼泊尔诊断和管理结核病的可靠工具。由于其高成本和可持续性，具有相似效率的替代性简单快速诊断方法将有助于尼泊尔的结核病控制。