Early tuberculosis (TB) diagnosis is critical for overall health, enabling prompt treatment initiation and decreased mortality. This study is aimed at evaluating the respective performances of Xpert MTB/RIF Ultra, BD MAX MDR-TB and Anyplex MTB/NTM compared to microbiological methods of diagnosing mycobacteria.

Respiratory specimens taken from a third-level hospital in Monterrey, Mexico between January 2025 and January 2026 were included. Samples were processed for mycobacteria identification by microbiological (Lowenstein-Jensen, MGIT culture, and MALDI-TOF mass spectrometry) and molecular methods (Xpert MTB/RIF Ultra, BD MAX MDR-TB, and Anyplex MTB/NTM). The diagnostic performance of each methodology was evaluated in terms of sensitivity and specificity, as well as degree of agreement between results.

During the study period, 131 samples were tested for microbiological culture and concomitantly processed by Anyplex ( n  = 121, 92.4%), BD Max ( n  = 82, 62.6%), and Xpert ( n  = 41, 31.3%). The sensitivity, specificity, and concordance of each molecular method with regard to microbiological culture was 100%, 70.4%, and κ  =  0.619 for Xpert; 97.1%, 83.7%, and κ = 0.728 for Anyplex; and 88.9%, 85.0% and κ = 0.730 for BD MAX. Comparison of Xpert, Anyplex, and BD MAX, including paired samples ( n  = 41), showed high sensitivity (100%, 100%, and 92.9%), moderate specificity (70.4%, 81.5%, and 77.5%), and good concordance (κ =0.619, 0.750, and 0.650) with microbiological culture.

All three molecular methods showed good concordance with the reference method for MTC detection. While Xpert had lower specificity than Anyplex and BD MAX, the three methodologies all showed good concordance with microbiological culture.