Clinical Management of Multidrug-Resistant Tuberculosis in 16 European Countries

Multidrug-resistant tuberculosis (MDR-TB) is a major burden to public health in Europe. Reported treatment success rates are around 50% or less, and cure rates are even lower. To document the management and treatment outcome in patients with MDR-TB in Europe. We performed a prospective cohort study,...

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Vydáno v:American journal of respiratory and critical care medicine Ročník 198; číslo 3; s. 379 - 386
Hlavní autoři: Günther, Gunar, van Leth, Frank, Alexandru, Sofia, Altet, Neus, Avsar, Korkut, Bang, Didi, Barbuta, Raisa, Bothamley, Graham, Ciobanu, Ana, Crudu, Valeriu, Danilovits, Manfred, Dedicoat, Martin, Duarte, Raquel, Gualano, Gina, Kunst, Heinke, de Lange, Wiel, Leimane, Vaira, McLaughlin, Anne-Marie, Magis-Escurra, Cecile, Muylle, Inge, Polcová, Veronika, Popa, Cristina, Rumetshofer, Rudolf, Skrahina, Alena, Solodovnikova, Varvara, Spinu, Victor, Tiberi, Simon, Viiklepp, Piret, Lange, Christoph
Médium: Journal Article
Jazyk:angličtina
Vydáno: United States American Thoracic Society 01.08.2018
Témata:
Antitubercular Agents - therapeutic use
Clinical outcomes
Cohort Studies
Drug resistance
Europe - epidemiology
Humans
Incidence
Laboratories
Multidrug resistant organisms
Patients
Prospective Studies
Treatment Outcome
Tuberculosis
Tuberculosis, Multidrug-Resistant - drug therapy
Tuberculosis, Multidrug-Resistant - epidemiology
Europe
Switzerland
extensively drug-resistant TB
TBNET
outcome definitions
MDR-TB
management
ISSN:1073-449X, 1535-4970, 1535-4970
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Shrnutí:Multidrug-resistant tuberculosis (MDR-TB) is a major burden to public health in Europe. Reported treatment success rates are around 50% or less, and cure rates are even lower. To document the management and treatment outcome in patients with MDR-TB in Europe. We performed a prospective cohort study, analyzing management and treatment outcomes stratified by incidence of patients with MDR-TB in Europe. Treatment outcomes were compared by World Health Organization and alternative simplified definitions by the Tuberculosis Network European Trialsgroup (TBNET). A total of 380 patients with MDR-TB were recruited and followed up between 2010 and 2014 in 16 European countries. Patients in high-incidence countries compared with low-incidence countries were treated more frequently with standardized regimen (83.2% vs. 9.9%), had delayed treatment initiation (median, 111 vs. 28 d), developed more additional drug resistance (23% vs. 5.8%), and had increased mortality (9.4% vs. 1.9%). Only 20.1% of patients using pyrazinamide had proven susceptibility to the drug. Applying World Health Organization outcome definitions, frequency of cure (38.7% vs. 9.7%) was higher in high-incidence countries. Simplified outcome definitions that include 1 year of follow-up after the end of treatment showed similar frequency of relapse-free cure in low- (58.3%), intermediate- (55.8%), and high-incidence (57.1%) countries, but highest frequency of failure in high-incidence countries (24.1% vs. 14.6%). Conventional standard MDR-TB treatment regimens resulted in a higher frequency of failure compared with individualized treatments. Overall, cure from MDR-TB is substantially more frequent than previously anticipated, and poorly reflected by World Health Organization outcome definitions.
Bibliografie:ObjectType-Article-1
SourceType-Scholarly Journals-1
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ISSN:1073-449X
1535-4970
1535-4970
DOI:10.1164/rccm.201710-2141OC