Table 1 Characteristics of studies included in the meta-analysis for rifampicin-resistance tuberculosis detection
From: Xpert MTB/RIF assay for the diagnosis of rifampicin resistance in different regions: a meta-analysis
Study | First author [ref.] | Year | Country | Study setting | Male (%) | HIV (%) | Age (year) (Median, IQR) | Patient selecting method | Total samples n (included n) | Specimen type (samples n) | Gold standard |
|---|---|---|---|---|---|---|---|---|---|---|---|
1 | Al-Ateah SM [15] | 2012 | Saudi Arabia | Laboratory | 126 (53.8) | 1 (0.4) | NR | Cross-sectional Unspecified | 234 (239) | Sputum (56), BAL (116); tissue (16), CSF (14), FNA (5), body fluid (22), abscess (10) | DST |
2 | Antonenka U [16] | 2013 | German | Clinical | NR | NR | NR | Retrospective Unspecified | 121 (121) | Respiratory specimens (121) | Solid or liquid media DST |
3 | Balcells ME [17] | 2012 | Chile | Clinical | 127 (79.4) | 160 (100) | Adults> 18 (37.4, 19–65) | Cross-sectional Prospective Consecutive | 160 (12) | Sputum (160) | Solid and liquid media DST |
4 | Barmankulova A [18] | 2015 | Kyrgyzstan | Laboratory | 172 (57.3) | NR | Median 34, IQR 25–45 | Cross-sectional Unspecified | 300 (191) | Sputum (300) | Solid and liquid media DST |
5 | Barnard M [19] | 2012 | South Africa | Laboratory | NR | NR | NR | Unspecified Consecutive | 282 (68) | Sputum (282) | DST |
6 | Bates M [20] | 2013 | Zambia | Clinical | NR | 22 (2.4) | Children≤15 | Prospective Unspecified | 930 (930) | Sputum, gastric lavage aspirate (930) | Liquid culture |
7 | Biadglegne F [21] | 2014 | Ethiopia | Clinical | 99 (42.9) | NR | 14.7% ≤ 14, 85.3% > 14 | Cross-sectional Unspecified | 231 (32) | Lymph node aspirates (231) | DST |
8 | Blakemore R [22] | 2010 | America | Clinical | NR | NR | NR | Unspecified Unspecified | 168 (79) | Sputum (168) | DST |
9 | Boehme CC [23] | 2010 |  | Clinical | 929 (53.7) | 392 (22.7) | Adults≥18 (34, 17–88) | Prospective Consecutive | 1730 (720) | Sputum (1730) | Solid media DST |
|  |  |  | Peru |  | 181 (53.1) | 3 (0.9) | Adults≥18 (31, 18–79) |  | 341 (209) | Sputum (341) | Solid media DST |
|  |  |  | Azerbaijan |  | 251 (71.1) | 9 (2.6) | Adults≥18 (37, 20–69) |  | 353 (143) | Sputum (353) | Solid or liquid media DST |
|  |  |  | South Africa |  | 357 (49.2) | 376 (51.8) | Adults≥18 (34, 18–74) |  | 726 (183) | Sputum (726) | Liquid media DST |
|  |  |  | India |  | 140 (45.2) | 4 (12.9) | Adults≥18 (30, 17–88) |  | 310 (185) | Sputum (310) | Liquid media DST |
10 | Boehme CC [24] | 2011 |  | Clinical | 4043 (60.8) | 1255 (18.9) | Adults≥18 (38, 29–50) | Unspecified Consecutive | 6648 (1060) | Sputum (6648) | DST |
|  |  |  | Peru |  | 607 (51.2) | 5 (0.4) | Adults≥18 (37, 26–53) |  | 1185 (185) | Sputum (1185) | Liquid media DST |
|  |  |  | Azerbaijan |  | 748 (99.9) | 1 (0.1) | Adults≥18 (36, 30–44) |  | 749 (211) | Sputum (749) | Liquid media DST |
|  |  |  | South Africa |  | 1275 (50.6) | 947 (37.5) | Adults≥18 (36, 29–46) |  | 2522 (188) | Sputum (2522) | Solid media DST |
|  |  |  | Uganda |  | 202 (54.3) | 254 (68.3) | Adults≥18 (32, 26–38) |  | 372 (116) | Sputum (372) | Solid media DST |
|  |  |  | India |  | 628 (69.6) | 40 (4.4) | Adults≥18 (45, 32–58) |  | 902 (103) | Sputum (902) | Solid media DST |
|  |  |  | Philippines |  | 583 (63.5) | 8 (0.9) | Adults≥18 (47, 34–58) |  | 918 (257) | Sputum (918) | DST |
11 | Bowles EC [25] | 2011 | Netherlands | Clinical | NR | NR | NR | Unspecified Unspecified | 89 (60) | Sputum (86), pleural fluid (1), gastric fluid (1), bronchial washing (1) | DST |
12 | Carriquiry G [26] | 2012 | Peru | Clinical | 95 (73) | 131 (100) | Adults≥18 (35, 29–42) | Cross-sectional Unspecified | 131 (39) | Sputum (131) | Solid and liquid media DST |
13 | Cayci YT [27] | 2017 | Turkey | Laboratory | NR | NR | NR | Unspecified Unspecified | 34 (34) | Respiratory (19) and Non-respirator specimens (15) | Liquid media DST |
14 | Chakravorty S [28] | 2017 | South, Africa, India | Laboratory | NR | NR | NR | Prospective Unspecified | 139 (139) | Sputum (139) | Liquid media DST |
15 | Chiang TY [29] | 2018 | China | Clinical | 876 (29.6) | NR | Median 55, IQR 35.8–70.0 | Prospective Unspecified | 2957 (697) | Sputum (697) | Solid and liquid culture |
16 | Chikaonda T [30] | 2017 | Malawi | Clinical | NR | 200 (57.0) | Adult≥18 | Retrospective Random | 351 (188) | Sputum (60) | Solid and liquid media DST |
17 | Ciftçi IH [31] | 2011 | Turkey | Clinical | NR | NR | NR | Unspecified Unspecified | 85 (24) | Sputum (50), BAL (25), thorasynthesis fluid (5), urine (5) | Liquid media DST |
18 | Deggim V [32] | 2013 | Switzerland | Clinical | NR | NR | NR | Prospective Unspecified | 79 (10) | Respiratory and Non-respirator specimens (79) | DST |
19 | Dharan NJ [33] | 2016 | Russia, Peru, Hong Kong, Haiti, USA | Clinical | 358 (65.8) | 536 (98.5) | Median 54.2, IQR 19–88 | Unspecified, Unspecified | 544 (185) | Sputum (185) | DST |
20 | Dorman SE [34] | 2012 | South Africa | Laboratory | 6469 (93.8) | 602 (8.7) | Median 43, IQR 34–49 | Cross-sectional Consecutive | 6893 (144) | Sputum (6893) | Liquid media DST |
21 | Dorman SE [35] | 2018 | South Africa, Uganda, Kenya, India, China, Georgia, Belarus, Brazil | Clinical | 1059 (60.4) | 441 (25.2) | Median 38, IQR 28–50 | Prospective Unspecified | 1753 (551) | Sputum (551) | Liquid media DST |
22 | Du J [36 | 2015 | China | Clinical | 70 (55.6) | 5 (4.0) | Adults> 16 (38.6, 25.4–51.8) | Unspecified Unspecified | 126 (126) | Pleural biopsy (126), pleural fluid specimens (126) | Liquid media DST |
23 | Feliciano CS [37] | 2018 | Brazil, Mozambique | Clinical | 22 (75.9) | 6 (20.7) | NR | Cross-sectional Unspecified | 29 (29) | NR (29) | Solid media DST |
24 | Giang do C [38] | 2015 | Vietnam | Clinical | 98 (65.3) | 0 (0) | Children< 15 (18.5 months, 5–170 months) | Prospective Consecutive | 150 (29) | Sputum (79), Gastric fluid (215), CSF (3), Pleural fluid (4), Cervical lymphadenopathic pus (1) | Liquid media DST |
25 | Gu Y [39] | 2015 | China | Clinical | 28 (46.7) | NR | Median 39.7, IQR 19.5–74.6 | Prospective Unspecified | 60 (24) | Pus specimens (60) | Liquid media DST |
26 | Guenaoui K [40] | 2016 | France | Laboratory | 35 (0.7) | NR | NR | Prospective Unspecified | 50 (50) | Sputum (50) | Liquid DST |
27 | Helb D [41] | 2010 | Uganda | Clinical | 38 (59.3) | 20 (31.3) | Median 34, IQR 18–60 | Retrospective Consecutive | 64 (64) | Sputum (64) | DST |
28 | Hillemann D [42] | 2011 | German | Laboratory | NR | NR | NR | Unspecified Consecutive | 521 (29) | Urine (91), gastric aspirate (30), tissue (245), pleural fluid (113), CSF (19), stool (23) | Liquid media DST |
29 | Huang H [43] | 2018 | China | Laboratory | NR | NR | NR | Retrospective Unspecified | 2910 (1066) | NR | Liquid media DST |
30 | Huh HJ [44] | 2014 | South Korea | Clinical | 197 (65.7) | 1 (0.3) | Median 58, IQR 18–93 | Retrospective Unspecified | 300 (98) | Sputum (264), Bronchial washing or BAL (39) | Solid and liquid media DST |
31 | Hu P [45] | 2014 | China | Laboratory | 1037 (76.7) | NR | 3.2% < 20, 96.8% ≥ 20 | Unspecified Consecutive | 1352 (332) | Sputum (1352) | Solid media DST |
32 | Jin YH [46] | 2017 | China | Clinical | 59 (54.1) | NR | Median 48.6, IQR 24.0–73.1 | Unspecified Unspecified | 109 (48) | Pus (48) | Liquid media DST |
33 | Kawkitinarong K [47] | 2017 | Thailand | Clinical | 284 (58.6) | 128 (25.9) | Median 41, IQR 30.8–54.3 | Prospective Unspecified | 521 (228) | Pulmonary specimens (228) | DST |
34 | Khalil KF [48] | 2015 | Pakistan | Clinical | 36 (38.7) | 0 (0) | > 16, 19.5–57.6 | Unspecified Consecutive | 93 (93) | BAL (93) | Solid media DST |
35 | Kim CH [49] | 2014 | South Korea | Clinical | 104 (60.8) | 1 (0.6) | Median 58.6, IQR 41.02–76.18 | Retrospective Unspecified | 171 (26) | Pulmonary (160), Non-pulmonary (38) specimens | Solid media DST |
36 | Kim CH [50] | 2015 | South Korea | Clinical | 217 (56.7) | 1 (0.3) | Median 56.31, IQR 38.43–74.18 | Retrospective Convenience | 383 (444) | Sputum (176), Bronchial washes (225), BAL (4); Pleural fluid (36), Tissue (1), Pericardial fluid (1), Lymph node (1) | Solid media DST |
37 | Kim MJ [51] | 2015 | South Korea | Laboratory | NR | NR | NR | Unspecified Convenience | 52 (45) | Sputum (36), bronchial washing (10), pleural fluid (3), pleural mass (1), urine (2) | Liquid media DST |
38 | Kim SY [52] | 2012 | South Korea | Clinical | NR | NR | NR | Unspecified Consecutive | 71 (62) | Sputum (71) | Solid and liquid DST |
39 | Kim YW [53] | 2015 | South Korea | Clinical | 761 (53.3) | 12 (0.8) | Median 59, IQR 0–99 | Retrospective Consecutive | 1429 (1540) | LN and tissue/pus (397), body fluid (469), CSF (254), joint fluid (283), urine (106), others (31) | Solid media DST |
40 | Kim YW [54] | 2015 | South Korea | Clinical | 196 (61.1) | NR | Median 56, IQR 38–71 | Retrospective Consecutive | 321 (321) | Sputum (321) | DST |
41 | Kokuto H [55] | 2015 | Japan | Clinical | 51 (54.8) | 0 (0) | Adult≥20 (59.6, 45.0–75.0) | Retrospective Convenience | 93 (56) | fecal specimens (93) | DST |
42 | Kostera J [56] | 2018 | Bangladesh | Clinical | NR | NR | NR | Unspecified Unspecified | 132 (122) | Sputum (122) | Liquid media DST |
43 | Kurbaniyazova G [57] | 2017 | Kyrgyzstan | Laboratory | NR | NR | Adult≥18 | Retrospective Unspecified | 2734 (364) (414) | NR | Solid and liquid media DST |
44 | Kurbatova EV [58] | 2013 | Russia | Clinical | NR | NR | Adults≥18 | Unspecified Consecutive | 201 (99) | Sputum (201) | Solid and liquid media DST |
45 | Kwak N [59] | 2013 | South Korea | Clinical | 426 (62.5) | 5 (0.7) | Median 61, IQR 47.5–73.0 | Retrospective Unspecified | 681 (127) | Sputum (127) | Solid media DST |
46 | Lawn SD [60] | 2011 | South Africa | Clinical | 162 (34.6) | 468 (100) | Adults≥18 (33.6, 27.8–40.7) | Prospective Consecutive | 468 (55) | Sputum (468) | Liquid media DST |
47 | Lee HY [61] | 2013 | South Korea | Clinical | 78 (59.1) | 1 (0.8) | Median 54.0, IQR 18–90 | Retrospective Unspecified | 132 (132) | Bronchoscopy specimens (132) | Ogawa media DST |
48 | Li Q [62] | 2016 | China | Laboratory | NR | NR | NR | Unspecified Consecutive | 1973 (449) | Sputum (449) | Liquid media DST |
49 | Li Y [63] | 2017 | China | Laboratory | 251 (60.6) | NR | Median 48.5, IQR 38.3–58.7 | Unspecified Consecutive | 420 (59) | Extra-pulmonary specimens (59) | Solid media DST |
50 | Liu X [64] | 2015 | China | Clinical | NR | NR | NR | Unspecified Unspecified | 134 (44) | Pleural biopsy and pleural fluid specimens (100) | Liquid media DST |
51 | Lorent N [65] | 2015 | Cambodia | Clinical | 160 (53.5) | 189 (64.5) | Median 43, IQR 34–52 | Prospective Consecutive | 299 (102) | Sputum (102) | Solid media DST |
52 | Luetkemeyer AF [66] | 2016 | USA South Africa Brazil | Laboratory | 446 (45.0) | 617 (62.2) | Median 46, IQR 35–64 | Unspecified Unspecified | 992 (194) | Sputum (2) | DST |
53 | Metcalfe JZ [67] | 2016 | Zimbabwe | Clinical | 216 (61.4) | 238 (67.6) | Median 36.3, IQR 29.0–44.4 | Prospective Consecutive | 352 (161) | Sputum (161) | Solid and liquid media DST |
54 | Mokaddas E [68] | 2015 | Kuwait | Laboratory | NR | NR | NR | Unspecified Unspecified | 452 (452) | Sputum (287), FNA (66), pus (58), pleural fluid (14), tissue (10), other sterile fluids (8), urine (5), CSF (2), stool (2). | Liquid media DST |
55 | Moon HW [69] | 2015 | South Korea | Clinical | NR | NR | NR | Unspecified Unspecified | 100 (100) | Respiratory specimens (100) | DST |
56 | Moure R [70] | 2011 | Spain | Clinical | NR | NR | NR | Retrospective Unspecified | 122 (85) | Sputum (92), BA (12), pulmonary biopsy (1); pleural fluid (4), gastric aspirate (5), urine (2), stool (1),cerebrospinal fluid (3), ascitic fluid (2), lymph node aspirate (1), skin biopsy (1), mammary abscess (1) | DST |
57 | Mwanza W [71] | 2018 | Zambia | Laboratory | NR | NR | NR | Unspecified Consecutive | 1070 (24) | NR (24) | Liquid media DST |
58 | Myneedu VP [72] | 2014 | India | Laboratory | NR | NR | NR | Unspecified Unspecified | 134 (88) | Sputum (134) | Liquid media DST |
59 | N’guessan K [73] | 2014 | Cote d’Ivoire | Clinical | 91 (75.8) | NR | Median 34.2, IQR 24.1–44.3 | Unspecified Unspecified | 120 (29) | Sputum (120) | Liquid media DST |
60 | N’Guessan K [74] | 2018 | Côte d’Ivoire | Clinical | 715 (65.3) | 130 (12) | Median 33, IQR 18–80 | Cross-sectional Consecutive | 1095 (162) | Sputum (162) | Liquid media DST |
61 | Nikolayevskyy V [75] | 2018 | Ukraine | Clinical | 2393 (68.8) | 1265 (36.4) | Median 38.3, IQR 27–51.6 | Retrospective Unspecified | 3478 (3167) | Pulmonary specimens (3167) | Solid and liquid media DST |
62 | Nicol MP [76] | 2011 | South Africa | Clinical | 250 (55.3) | 108 (23.9) | Children≤15 (19.4 months, 11.1–46.2 months) | Prospective Consecutive | 452 (77) | Sputum (452) | DST |
63 | O’Grady J [77] | 2012 | Zambia | Clinical | 446 (50.6) | 595 (67.5) | Adults> 15 (35, 28–43) | Prospective Unspecified | 881 (96) | Sputum (881) | Liquid media DST |
64 | Ou X [78] | 2014 | China | Laboratory | 1741 (70.9) | NR | NR | Unspecified Consecutive | 2454 (616) | Sputum (2454) | Solid media DST |
65 | Ozkutuk N [79] | 2014 | Turkey | Laboratory | NR | NR | NR | Unspecified Unspecified | 2639 (133) | Sputum (721), BAL (757), gastric fluid (94), endotracheal aspirates (30), transtracheal aspirate (9); urine (341), pleural fluid (232), tissue (176), CSF (111), abscesses (94), peritoneal fluid (42), pericardial fluid (18), joint fluid (7), other (7) | Liquid media DST |
66 | Pan X [80] | 2018 | China | Clinical | 120 (63.2) | NR | Median 46.7, IQR 16–84 | Prospective Unspecified | 190 (62) | Sputum,BAL (62) | DST |
67 | Pang Y [81] | 2014 | China | Clinical | 128 | NR | Children< 14 | Prospective Consecutive | 211 (10) | Gastric lavage aspirates (211) | Liquid media DST |
68 | Park KS [82] | 2013 | South Korea | Clinical | NR | NR | NR | Prospective Consecutive | 320 (19) | Respiratory specimens (320) | Liquid media DST |
69 | Pimkina E [83] | 2015 | Lithuania | Laboratory | 559 (70.6) | NR | Age ≥ 15 | Retrospective Unspecified | 791 (264) | Respiratory specimens (264) | Solid or liquid media DST |
70 | Pinyopornpanish K [84] | 2015 | Thailand | Clinical | 34 (59.6) | 15 (26.3) | ≥15 (55.6, 35.5–75.7) | Cross-sectional Consecutive | 57 (43) | Sputum(57) | Liquid media DST |
71 | Rachow A [85] | 2011 | Tanzania | Clinical | 141 (48.3) | 172 (58.9) | Median 39.2 | Unspecified Consecutive | 292 (61) | Sputum (292) | Liquid media DST |
72 | Rahman A [86] | 2016 | Bangladesh | Clinical | NR | NR | NR | Unspecified Unspecified | 92 (92) | Sputum (92) | Liquid media DST |
73 | Raizada N [87] | 2014 | India | Clinical | 2339 (50.8) | NR | Children< 14 | Prospective Consecutive | 4600 (48) | Sputum (4600) | DST |
74 | Reither K [88] | 2015 | Tanzania Uganda | Clinical | 219 (45.6) | 197 (43.7) | Children< 16 (5.6, 2.0–9.8) | Prospective Consecutive | 451 (25) | Sputum (451) | Liquid media DST |
75 | Rice JP [89] | 2017 | America | Laboratory | NR | NR | Median 50, IQR 35–60 | Retrospective Unspecified | 637 (120) | Sputum (120) | Liquid media DST |
76 | Sharma SK [90] | 2015 | India | Laboratory | 909 (64.7) | NR | Median 37.5, IQR 19.4–55.6 | Unspecified Consecutive | 1406 (422) | Respiratory specimens (422) | Solid and liquid media DST |
77 | Sharma SK [91] | 2017 | India | Laboratory | 1405 (55.6) | NR | Median 35.29, IQR 20–50 | Unspecified Convenient | 2468 (328) | Extra-pulmonary specimens (328) | Liquid media DST |
78 | Singh UB [92] | 2016 | India | Clinical | 589 (51.4) | NR | NR | Prospective Unspecified | 1145 (72) | Pulmonary and Extra-pulmonary specimens (132) | Liquid media DST |
79 | Soeroto AY [93] | 2019 | Indonesia | Clinical | 193 (56.9) | 5 (1.5) | Median 38.2, IQR 25.7–50.7 | Retrospective Unspecified | 339 (158) | NR (158) | DST |
80 | Ssengooba W [94] | 2014 | Uganda | Clinical | 155 (36.6) | 424 (100) | Median 32, IQR 32–34 | Prospective Unspecified | 424 (9) | Sputum (424) | Liquid media DST |
81 | Strydom K [95] | 2015 | South Africa | Laboratory | NR | NR | NR | Retrospective Consecutive | 120 (115) | Sputum (120) | Liquid media DST |
82 | Tahseen S [96] | 2016 | Pakistan | Clinical | 1078 (54.3) | NR | Median 33 | Cross-sectional Consecutive | 1984 (1533) | Sputum (1533) | Solid media DST |
83 | Theron G [97] | 2011 | South Africa | Clinical | 325 (67.7) | 130 (27.1) | Adults≥18 (36, 18–83) | Unspecified Consecutive | 480 (157) | Sputum (480) | Liquid media DST |
84 | Tsuyuguchi K [98] | 2017 | Japan | Clinical | 146 (61.6) | NR | Median 65.2, IQR 23–94 | Prospective Consecutive | 237 (201) | Sputum (201) | Solid media DST |
85 | Ullah I [99] | 2017 | Pakistan | Clinical | 130 (48.9) | 0 (0) | Median 34, IQR 3–80 | Unspecified Unspecified | 266 (88) | Extra-pulmonary specimens (88) | DST |
86 | Vadwai V [100] | 2011 | India | Clinical | 251 (45.9) | 16 (2.9) | Median 37, IQR 8 months-94 | Unspecified Consecutive | 547 (125) | Biopsy (284), pus (147), body fluids (93), CSF (23) | Solid and liquid media DST |
87 | van Kampen SC [101] | 2015 | Kazakhstan | Laboratory | NR | 52(0.9) | NR | Prospective Consecutive | 5611 (1054) | Sputum (5611) | Solid or liquid media DST |
88 | van Kampen SC [102] | 2015 | Indonesia | Clinical | 872 (60.5), missing 15(1.0) | 35 (2.4) | 0.5% < 15, 97.7% ≥ 16, 1.8% missing | Unspecified Consecutive | 1442 (339) | Sputum (1442) | DST |
89 | Wang G [103] | 2017 | China | Clinical | NR | NR | NR | Prospective Undefined | 1461 (538) | Pulmonary specimens (1063), extra-pulmonary specimens (398) | Solid media DST |
90 | Wang G [104] | 2019 | China | Clinical | 192 (65.75) | 0 (0) | Median 42, IQR 14–89 | Prospective Consecutive | 292 (119) | Sputum (90), pleural fluid (29) | Solid or liquid media DST |
91 | Williamson DA [105] | 2012 | New Zealand | Clinical | NR | NR | NR | Unspecified Unspecified | 169 (14) | Respiratory specimens (89); extra-pulmonary specimens (9), MGIT liquid culture vials (71) | Liquid media DST |
92 | Yin QQ [106] | 2014 | China | Clinical | 141 (55.3) | NR | Children≤18 (6.1, 0.3–15.3) | Unspecified Unspecified | 255 (21) | BALF (255) | Liquid media DST |
93 | Yuan M [107] | 2016 | China | Clinical | NR | 0 (0) | NR | Retrospective Unspecified | 328 (90) | Extra-pulmonary specimens (90) | DST |
94 | Zar HJ [108] | 2012 | South Africa | Clinical | 294 (55.0) | 117 (21.9) | Children< 15 (19.0 months, 11.2–38.3 months) | Unspecified Consecutive | 535 (125) | Nasopharyngeal specimens, sputum (535) | Liquid culture |
95 | Zar HJ [109] | 2014 | South Africa | Clinical | 181 (47) | 31 (8) | Children< 15 (38.3 months, 21.2–56.5 months) | Prospective Consecutive | 384 (18) | Sputum (309), Nasopharyngeal aspirate specimens (309) | DST |
96 | Zetola NM [110] | 2014 | Botswana | Clinical | 221 (59.7) | 279 (59.4) | Adult≥18 (37, 31–44) | Retrospective Consecutive | 370 (370) | Sputum (370) | DST |
97 | Zhang AM [111] | 2016 | China | Clinical | 65 (59.6) | 0 (0) | Children≤14 | Unspecified Unspecified | 109 (21) | Pulmonary and Extra-pulmonary specimens (21) | Liquid media DST |