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

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 report...

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Published in:The European respiratory journal Vol. 48; no. 4; pp. 1160 - 1170
Main Authors: 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
Format: Journal Article
Language:English
Published: England 01.10.2016
Subjects:
Adult
Antitubercular Agents - therapeutic use
Cohort Studies
Coinfection
Female
Humans
Kaplan-Meier Estimate
Male
Microbial Sensitivity Tests
Middle Aged
Mycobacterium tuberculosis - drug effects
Proportional Hazards Models
Risk
Sputum - microbiology
Treatment Failure
Tuberculosis, Multidrug-Resistant - therapy
Tuberculosis, Pulmonary - diagnosis
ISSN:1399-3003
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Summary: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.
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ISSN:1399-3003
DOI:10.1183/13993003.00462-2016