Обзорная статья

Drug resistance beyond extensively drug-resistant tuberculosis: individual patient data meta-analysis

Giovanni Battista MiglioriWorld Health Organization Collaborating Centre for Tuberculosis and Lung Diseases, Fondazione S. Maugeri, Care and Research Institute, Tradate, ItalyGiovanni SotgiuEpidemiology and Medical Statistics Unit, Department of Biomedical Sciences, University of Sassari, Sassari, ItalyNeel R. GandhiDepartment of Medicine and Department of Epidemiology and Population Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USADennis FalzonSTOP TB Department, World Health Organization, Geneva, SwitzerlandKathryn DeRiemerSchool of Medicine, University of California Davis, Davis, California, USARosella CentisWorld Health Organization Collaborating Centre for Tuberculosis and Lung Diseases, Fondazione S. Maugeri, Care and Research Institute, Tradate, ItalyMaria-Graciela Hollm-DelgadoMontreal Chest Institute, McGill University, Montreal, CanadaDomingo PalmeroPulmonology Division, Hospital F. J. Muñiz, Buenos Aires, ArgentinaCarlos Pérez-GuzmánInstituto de Servicios de Salud del Estado de Aguascalientes, and Unidad de Medicina Ambulatoria Aguascalientes, Instituto Mexicano del Seguro Social, Aguascalientes, MexicoMario H. VargasInstituto Nacional de Enfermedades Respiratorias, and Medical Research Unit in Respiratory Diseases, Instituto Mexicano del Seguro Social, Mexico DF, MexicoLia D’AmbrosioWorld Health Organization Collaborating Centre for Tuberculosis and Lung Diseases, Fondazione S. Maugeri, Care and Research Institute, Tradate, ItalyAntonio SpanevelloUniversità degli Studi dell'Insubria, Varese, and Fondazione S. Maugeri, Care and Research Institute, Tradate, ItalyMelissa BauerMontreal Chest Institute, McGill University, Montreal, CanadaEdward D. ChanPulmonary Department, Denver Veterans Affair Medical Center and National Jewish Health, Denver, Colorado, USAH. Simon SchaafDesmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University, Tygerberg, South AfricaSalmaan KeshavjeeDepartment of Global Health & Social Medicine Harvard Medical School, Boston, Massachusetts, USATimothy H. HoltzCenters for Disease Control and Prevention, Atlanta, GA, USADick MenziesMontreal Chest Institute, McGill University, Montreal, CanadaThe Collaborative Group for Meta-Analysis of Individual Patient Data in MDR-TBA full list of the Collaborative Group for Meta-Analysis of Individual Patient Data in MDR-TB members can be found in the Acknowledgements section

2012en

ABI

Аннотация

The broadest pattern of tuberculosis (TB) drug resistance for which a consensus definition exists is extensively drug-resistant (XDR)-TB. It is not known if additional drug resistance portends worsened patient outcomes. This study compares treatment outcomes of XDR-TB patients with and without additional resistance in order to explore the need for a new definition. Individual patient data on XDR-TB outcomes were included in a meta-analysis comparing outcomes between XDR alone and three nonmutually exclusive XDR-TB patient groups: XDR plus resistance to all the second-line injectables (sli) and capreomycin and kanamycin/amikacin (XDR+2sli) XDR plus resistance to second-line injectables and to more than one group 4 drug, i.e. ethionamide/protionamide, cycloserine/terizidone or para-aminosalicylic acid (XDR+sliG4) and XDR+sliG4 plus resistance to ethambutol and/or pyrazinamide (XDR+sliG4EZ). Of 405 XDR-TB cases, 301 were XDR alone, 68 XDR+2sli, 48 XDR+sliG4 and 42 XDR+sliG4EZ. In multivariate analysis, the odds of cure were significantly lower in XDR+2sli (adjusted OR 0.4, 95% CI 0.2-0.8) compared to XDR alone, while odds of failure and death were higher in all XDR patients with additional resistance (adjusted OR 2.6-2.8). Patients with additional resistance beyond XDR-TB showed poorer outcomes. Limitations in availability, accuracy and reproducibility of current drug susceptibility testing methods preclude the adoption of a useful definition beyond the one currently used for XDR-TB.

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Идентификаторы

DOI: 10.1183/09031936.00136312

Цитирования и источники

Цитирований: 2Использованных источников: 0

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