Surgery as an Adjunctive Treatment for Multidrug-Resistant Tuberculosis: An Individual Patient Data Metaanalysis

Medical treatment for multidrug-resistant (MDR)-tuberculosis is complex, toxic, and associated with poor outcomes. Surgical lung resection may be used as an adjunct to medical therapy, with the intent of reducing bacterial burden and improving cure rates. We conducted an individual patient data meta...

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Vydané v:Clinical infectious diseases Ročník 62; číslo 7; s. 887 - 895
Hlavní autori: Fox, Gregory J, Mitnick, Carole D, Benedetti, Andrea, Chan, Edward D, Becerra, Mercedes, Chiang, Chen-Yuan, Keshavjee, Salmaan, Koh, Won-Jung, Shiraishi, Yuji, Viiklepp, Piret, Yim, Jae-Joon, Pasvol, Geoffrey, Robert, Jerome, Shim, Tae Sun, Shin, Sonya S, Menzies, Dick, Ahuja, S, Ashkin, D, Avendaño, M, Banerjee, R, Bauer, M, Burgos, M, Centis, R, Cobelens, F, Cox, H, D'Ambrosio, L, de Lange, W C M, DeRiemer, K, Enarson, D, Falzon, D, Flanagan, K, Flood, J, Gandhi, N, Garcia-Garcia, L, Granich, R M, Hollm-Delgado, M G, Holtz, T H, Hopewell, P, Iseman, M, Jarlsberg, L G, Kim, H R, Lancaster, J, Lange, C, Leimane, V, Leung, C C, Li, J, Menzies, D, Migliori, G B, Narita, M, Nathanson, E, Odendaal, R, O'Riordan, P, Pai, M, Palmero, D, Park, S K, Pena, J, Pérez-Guzmán, C, Ponce-de-Leon, A, Quelapio, M I D, Quy, H T, Riekstina, V, Royce, S, Salim, M, Schaaf, H S, Seung, K J, Shah, L, Shean, K, Sifuentes-Osornio, J, Sotgiu, G, Strand, M J, Sung, S W, Tabarsi, P, Tupasi, T E, Vargas, M H, van Altena, R, van der Walt, M, van der Werf, T S, Westenhouse, J, Yew, W W
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: United States 01.04.2016
Predmet:
Adult
Antitubercular Agents - therapeutic use
Combined Modality Therapy
Female
Humans
Male
Middle Aged
Pneumonectomy - statistics & numerical data
Treatment Outcome
Tuberculosis, Multidrug-Resistant - drug therapy
Tuberculosis, Multidrug-Resistant - epidemiology
Tuberculosis, Multidrug-Resistant - surgery
Tuberculosis, Pulmonary - drug therapy
Tuberculosis, Pulmonary - epidemiology
Tuberculosis, Pulmonary - surgery
metaanalysis
multidrug resistant tuberculosis
pneumonectomy
individual patient data
thoracic surgery
ISSN:1537-6591
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Tagy: Pridať tag
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Abstract Medical treatment for multidrug-resistant (MDR)-tuberculosis is complex, toxic, and associated with poor outcomes. Surgical lung resection may be used as an adjunct to medical therapy, with the intent of reducing bacterial burden and improving cure rates. We conducted an individual patient data metaanalysis to evaluate the effectiveness of surgery as adjunctive therapy for MDR-tuberculosis. Individual patient data, was obtained from the authors of 26 cohort studies, identified from 3 systematic reviews of MDR-tuberculosis treatment. Data included the clinical characteristics and medical and surgical therapy of each patient. Primary analyses compared treatment success (cure and completion) to a combined outcome of failure, relapse, or death. The effects of all forms of resection surgery, pneumonectomy, and partial lung resection were evaluated. A total of 4238 patients from 18 surgical studies and 2193 patients from 8 nonsurgical studies were included. Pulmonary resection surgery was performed on 478 patients. Partial lung resection surgery was associated with improved treatment success (adjusted odds ratio [aOR], 3.0; 95% confidence interval [CI], 1.5-5.9; I(2)R, 11.8%), but pneumonectomy was not (aOR, 1.1; 95% CI, .6-2.3; I(2)R, 13.2%). Treatment success was more likely when surgery was performed after culture conversion than before conversion (aOR, 2.6; 95% CI, 0.9-7.1; I(2)R, 0.2%). Partial lung resection, but not pneumonectomy, was associated with improved treatment success among patients with MDR-tuberculosis. Although improved outcomes may reflect patient selection, partial lung resection surgery after culture conversion may improve treatment outcomes in patients who receive optimal medical therapy.
AbstractList Medical treatment for multidrug-resistant (MDR)-tuberculosis is complex, toxic, and associated with poor outcomes. Surgical lung resection may be used as an adjunct to medical therapy, with the intent of reducing bacterial burden and improving cure rates. We conducted an individual patient data metaanalysis to evaluate the effectiveness of surgery as adjunctive therapy for MDR-tuberculosis. Individual patient data, was obtained from the authors of 26 cohort studies, identified from 3 systematic reviews of MDR-tuberculosis treatment. Data included the clinical characteristics and medical and surgical therapy of each patient. Primary analyses compared treatment success (cure and completion) to a combined outcome of failure, relapse, or death. The effects of all forms of resection surgery, pneumonectomy, and partial lung resection were evaluated. A total of 4238 patients from 18 surgical studies and 2193 patients from 8 nonsurgical studies were included. Pulmonary resection surgery was performed on 478 patients. Partial lung resection surgery was associated with improved treatment success (adjusted odds ratio [aOR], 3.0; 95% confidence interval [CI], 1.5-5.9; I(2)R, 11.8%), but pneumonectomy was not (aOR, 1.1; 95% CI, .6-2.3; I(2)R, 13.2%). Treatment success was more likely when surgery was performed after culture conversion than before conversion (aOR, 2.6; 95% CI, 0.9-7.1; I(2)R, 0.2%). Partial lung resection, but not pneumonectomy, was associated with improved treatment success among patients with MDR-tuberculosis. Although improved outcomes may reflect patient selection, partial lung resection surgery after culture conversion may improve treatment outcomes in patients who receive optimal medical therapy.
BACKGROUNDMedical treatment for multidrug-resistant (MDR)-tuberculosis is complex, toxic, and associated with poor outcomes. Surgical lung resection may be used as an adjunct to medical therapy, with the intent of reducing bacterial burden and improving cure rates. We conducted an individual patient data metaanalysis to evaluate the effectiveness of surgery as adjunctive therapy for MDR-tuberculosis.METHODSIndividual patient data, was obtained from the authors of 26 cohort studies, identified from 3 systematic reviews of MDR-tuberculosis treatment. Data included the clinical characteristics and medical and surgical therapy of each patient. Primary analyses compared treatment success (cure and completion) to a combined outcome of failure, relapse, or death. The effects of all forms of resection surgery, pneumonectomy, and partial lung resection were evaluated.RESULTSA total of 4238 patients from 18 surgical studies and 2193 patients from 8 nonsurgical studies were included. Pulmonary resection surgery was performed on 478 patients. Partial lung resection surgery was associated with improved treatment success (adjusted odds ratio [aOR], 3.0; 95% confidence interval [CI], 1.5-5.9; I(2)R, 11.8%), but pneumonectomy was not (aOR, 1.1; 95% CI, .6-2.3; I(2)R, 13.2%). Treatment success was more likely when surgery was performed after culture conversion than before conversion (aOR, 2.6; 95% CI, 0.9-7.1; I(2)R, 0.2%).CONCLUSIONSPartial lung resection, but not pneumonectomy, was associated with improved treatment success among patients with MDR-tuberculosis. Although improved outcomes may reflect patient selection, partial lung resection surgery after culture conversion may improve treatment outcomes in patients who receive optimal medical therapy.
Author Garcia-Garcia, L
Quelapio, M I D
Ponce-de-Leon, A
Shim, Tae Sun
Granich, R M
Hopewell, P
Schaaf, H S
Flanagan, K
Lancaster, J
Royce, S
Shean, K
D'Ambrosio, L
Benedetti, Andrea
Strand, M J
Viiklepp, Piret
Cobelens, F
Menzies, D
van der Walt, M
Quy, H T
Koh, Won-Jung
Vargas, M H
van der Werf, T S
Hollm-Delgado, M G
Tabarsi, P
Burgos, M
Ahuja, S
Narita, M
Holtz, T H
Tupasi, T E
Enarson, D
Falzon, D
Fox, Gregory J
DeRiemer, K
Salim, M
Yim, Jae-Joon
Leimane, V
Westenhouse, J
Centis, R
Pérez-Guzmán, C
Avendaño, M
Palmero, D
Mitnick, Carole D
Sung, S W
Chan, Edward D
Cox, H
Gandhi, N
Sifuentes-Osornio, J
Menzies, Dick
O'Riordan, P
Yew, W W
Li, J
Pena, J
Chiang, Chen-Yuan
de Lange, W C M
Park, S K
Riekstina, V
Becerra, Mercedes
Keshavjee, Salmaan
Iseman, M
Robert, Jerome
Kim, H R
Shah, L
Odendaal, R
Shiraishi, Yuji
Nathanson, E
Banerjee, R
Shin, Sonya S
Flood, J
Migliori, G B
Jarlsberg, L G
Seung, K J
Bauer, M
Pai, M
Pasvol, Geoffrey
Ashkin, D
Lange, C
Sotgiu, G
Leung, C C
van Altena, R
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BackLink https://www.ncbi.nlm.nih.gov/pubmed/26757804$$D View this record in MEDLINE/PubMed
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ContentType Journal Article
Copyright The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.
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Issue 7
Keywords metaanalysis
multidrug resistant tuberculosis
pneumonectomy
individual patient data
thoracic surgery
Language English
License The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.
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PublicationTitle Clinical infectious diseases
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Snippet Medical treatment for multidrug-resistant (MDR)-tuberculosis is complex, toxic, and associated with poor outcomes. Surgical lung resection may be used as an...
BACKGROUNDMedical treatment for multidrug-resistant (MDR)-tuberculosis is complex, toxic, and associated with poor outcomes. Surgical lung resection may be...
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SubjectTerms Adult
Antitubercular Agents - therapeutic use
Combined Modality Therapy
Female
Humans
Male
Middle Aged
Pneumonectomy - statistics & numerical data
Treatment Outcome
Tuberculosis, Multidrug-Resistant - drug therapy
Tuberculosis, Multidrug-Resistant - epidemiology
Tuberculosis, Multidrug-Resistant - surgery
Tuberculosis, Pulmonary - drug therapy
Tuberculosis, Pulmonary - epidemiology
Tuberculosis, Pulmonary - surgery
Title Surgery as an Adjunctive Treatment for Multidrug-Resistant Tuberculosis: An Individual Patient Data Metaanalysis
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