Multidrug-resistant tuberculosis treatment failure detection depends on monitoring interval and microbiological method

Details

• Alternative Title:
  Eur Respir J
• Personal Author:
  Mitnick, Carole D. ; White, Richard A. ; Lu, Chunling ; Rodriguez, Carly A. ; Bayona, Jaime ; Becerra, Mercedes C. ; Burgos, Marcos ; Centis, Rosella ; Cohen, Theodore ; Cox, Helen ; D'Ambrosio, Lia ; Danilovitz, Manfred ; Falzon, Dennis ; Gelmanova, Irina Y. ; Gler, Maria T. ; Grinsdale, Jennifer A. ; Holtz, Timothy H. ; Keshavjee, Salmaan ; Leimane, Vaira ; Menzies, Dick ; Migliori, Giovanni Battista ; Milstein, Meredith B. ; Mishustin, Sergey P. ; Pagano, Marcello ; Quelapio, Maria I. ; Shean, Karen ; Shin, Sonya S. ; Tolman, Arielle W. ; van der Walt, Martha L. ; Van Deun, Armand ; Viiklepp, Piret
• Description:
  Debate persists about monitoring method (culture or smear) and interval (monthly or less frequently) during treatment for multidrug-resistant tuberculosis (MDR-TB). We analysed existing data and estimated the effect of monitoring strategies on timing of failure detection.We identified studies reporting microbiological response to MDR-TB treatment and solicited individual patient data from authors. Frailty survival models were used to estimate pooled relative risk of failure detection in the last 12 months of treatment; hazard of failure using monthly culture was the reference.Data were obtained for 5410 patients across 12 observational studies. During the last 12 months of treatment, failure detection occurred in a median of 3 months by monthly culture; failure detection was delayed by 2, 7, and 9 months relying on bimonthly culture, monthly smear and bimonthly smear, respectively. Risk (95% CI) of failure detection delay resulting from monthly smear relative to culture is 0.38 (0.34-0.42) for all patients and 0.33 (0.25-0.42) for HIV-co-infected patients.Failure detection is delayed by reducing the sensitivity and frequency of the monitoring method. Monthly monitoring of sputum cultures from patients receiving MDR-TB treatment is recommended. Expanded laboratory capacity is needed for high-quality culture, and for smear microscopy and rapid molecular tests.
• Subjects:
  Adult Antitubercular Agents Cohort Studies Coinfection Female Humans Kaplan-Meier Estimate Male Microbial Sensitivity Tests Middle Aged Mycobacterium Tuberculosis Proportional Hazards Models Risk Sputum Treatment Failure Tuberculosis, Multidrug-Resistant Tuberculosis, Pulmonary

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• Source:
  Eur Respir J. 2016; 48(4):1160-1170.
• Pubmed ID:
  27587552
• Pubmed Central ID:
  PMC5045442
• Document Type:
  Journal Article
• Funding:
  K01 HL080939/HL/NHLBI NIH HHS/United States
• Volume:
  48
• Issue:
  4
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:ad28f96b404269ec30ec7ddfeda1658f68c1b79c4dd8e3ec26b30a3e87406355
• Download URL:
  https://stacks.cdc.gov/view/cdc/42897/cdc_42897_DS1.pdf
• File Type:
  [PDF - 482.18 KB ]