Статья

Multidrug-Resistant Tuberculosis Treatment Outcomes in Relation to Treatment and Initial Versus Acquired Second-Line Drug Resistance

J. Peter CegielskiUS Centers for Disease Control and Prevention 1 , Atlanta, GeorgiaEkaterina V. KurbatovaUS Centers for Disease Control and Prevention 1 , Atlanta, GeorgiaMartie van der WaltMedical Research Council 3 , Pretoria ,Jeannette BrandMedical Research Council 3 , Pretoria ,Julia ErshovaUS Centers for Disease Control and Prevention 1 , Atlanta, GeorgiaThelma E. TupasiTropical Disease Foundation 4 , Manila ,Janice CaoiliTropical Disease Foundation 4 , Manila ,Tracy DaltonUS Centers for Disease Control and Prevention 1 , Atlanta, GeorgiaCarmen ContrerasSocios en Salud Sucursal 5Martín YaguiNational Institute of Health 6 , Lima ,Jaime BayonaSocios en Salud Sucursal 5Charlotte KvasnovskyUS Centers for Disease Control and Prevention 1 , Atlanta, GeorgiaVaira LeimaneRiga East University Hospital Centre of Tuberculosis and Lung Diseases 7 ,Līga KukšaRiga East University Hospital Centre of Tuberculosis and Lung Diseases 7 ,Michael P. ChenUS Centers for Disease Control and Prevention 1 , Atlanta, GeorgiaLaura E. ViaNational Institute for Allergy and Infectious Disease, National Institutes of Health 2 , Bethesda, MarylandSoo Hee HwangNational Masan Hospital 8 , ChangwonMelanie WolfgangUS Centers for Disease Control and Prevention 1 , Atlanta, GeorgiaGrigory VolchenkovTatiana R. SomovaSarah E. SmithUS Centers for Disease Control and Prevention 1 , Atlanta, GeorgiaSomsak AkksilpMinistry of Health 13 , BangkokWanpen WattanaamornkietOffice of Disease Prevention and Control Region 7 14 , Ubon Ratchathani ,Hee Jin KimKorean Institute of Tuberculosis 9 , Seoul ,Changki KimKorean Institute of Tuberculosis 9 , Seoul ,Boris Y. KazennyyOrel Oblast Tuberculosis Dispensary 11Tatiana KhoroshevaOrel Oblast Tuberculosis Dispensary 11Kai KliimanTartu University Hospital 15Piret ViikleppNational Tuberculosis Registry, National Institute for Health Development, 16 Tallinn, EstoniaRuwen JouAngela HuangI. А. VаsilyevаCentral Tuberculosis Research Institute, Russian Academy of Medical Sciences 12 , Moscow ,Olga V. DemikhovaCentral Tuberculosis Research Institute, Russian Academy of Medical Sciences 12 , Moscow ,on behalf of the Global PETTS InvestigatorsJoey LancasterRonel OdendaalLois DiemMaria T. PerezTarcela GlerK K TanCésar Antonio Bonilla-AsaldeOswaldo JaveLuis AsenciosGloria YaleCarmen SuárezAllison Taylor WalkerInga NorvaishaĢirts ŠķendersIngrida StureVija RiekstiņaAndra CīruleErika SigmanSang Nae ChoYing CaiSeok‐Yong EumJongseok LeeSeung-Kyu ParkDoosoo JeonIsdore Chola ShamputaBeverly MetchockTatiana KuznetsovaRattanawadee AkksilpWanlaya SittiJirapan InyapongE. V. KiryanovaI. I. DegtyarevaEvgenia S. NemtsovaKlavdia LevinaManfred DanilovitšTiina KummikYung-Chao LeiWeilun HuangВ В ЕрохинЛ. Н. ЧерноусоваSofia N. AndreevskayaЕ. Е. ЛарионоваTatyana Smirnova

2015en

ABI

Аннотация

BACKGROUND: Resistance to second-line drugs develops during treatment of multidrug-resistant (MDR) tuberculosis, but the impact on treatment outcome has not been determined. METHODS: Patients with MDR tuberculosis starting second-line drug treatment were enrolled in a prospective cohort study. Sputum cultures were analyzed at a central reference laboratory. We compared subjects with successful and poor treatment outcomes in terms of (1) initial and acquired resistance to fluoroquinolones and second-line injectable drugs (SLIs) and (2) treatment regimens. RESULTS: Of 1244 patients with MDR tuberculosis, 973 (78.2%) had known outcomes and 232 (18.6%) were lost to follow-up. Among those with known outcomes, treatment succeeded in 85.8% with plain MDR tuberculosis, 69.7% with initial resistance to either a fluoroquinolone or an SLI, 37.5% with acquired resistance to a fluoroquinolone or SLI, 29.3% with initial and 13.0% with acquired extensively drug-resistant tuberculosis (P < .001 for trend). In contrast, among those with known outcomes, treatment success increased stepwise from 41.6% to 92.3% as the number of drugs proven effective increased from ≤1 to ≥5 (P < .001 for trend), while acquired drug resistance decreased from 12% to 16% range, depending on the drug, down to 0%-2% (P < .001 for trend). In multivariable analysis, the adjusted odds of treatment success decreased 0.62-fold (95% confidence interval, .56-.69) for each increment in drug resistance and increased 2.1-fold (1.40-3.18) for each additional effective drug, controlling for differences between programs and patients. Specific treatment, patient, and program variables were also associated with treatment outcome. CONCLUSIONS: Increasing drug resistance was associated in a logical stepwise manner with poor treatment outcomes. Acquired resistance was worse than initial resistance to the same drugs. Increasing numbers of effective drugs, specific drugs, and specific program characteristics were associated with better outcomes and less acquired resistance.

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Идентификаторы

DOI: 10.1093/cid/civ910

Цитирования и источники

Цитирований: 3Использованных источников: 0

Показатели — AkademScholar