Towards tailored regimens in the treatment of drug-resistant tuberculosis: a retrospective study in two Italian reference Centres

Background The increased incidence of drug-resistant TB is a major challenge for effective TB control. Limited therapeutic options and poor treatment outcomes of DR-TB may increase drug-resistance rates. The objective of the study is to retrospectively compare MDR-TB and pre-XDR-TB treatment regimen...

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Vydáno v:BMC infectious diseases Ročník 19; číslo 1; s. 564 - 9
Hlavní autoři: Riccardi, Niccolò, Alagna, Riccardo, Saderi, Laura, Ferrarese, Maurizio, Castellotti, Paola, Mazzola, Ester, De Lorenzo, Saverio, Viggiani, Pietro, Udwadia, Zarir, Besozzi, Giorgio, Cirillo, Daniela, Sotgiu, Giovanni, Codecasa, Luigi
Médium: Journal Article
Jazyk:angličtina
Vydáno: London BioMed Central 28.06.2019
BioMed Central Ltd
BMC
Témata:
Amikacin
Antibacterial agents
Antitubercular agents
Drug resistance
Drug therapy
DST
Health aspects
HIV
Individualized regimen
Infectious Diseases
Internal Medicine
Linezolid
Medical Microbiology
Medicine
Medicine & Public Health
Methods
Microbial drug resistance
Mortality
Parasitology
Patient outcomes
Pre-XDR-TB
Precision medicine
Research Article
Statistics
Tropical Medicine
Tuberculosis
Tuberculosis and other mycobacterial diseases
Italy
Individualized regimen
Tuberculosis
DST
Pre-XDR-TB
ISSN:1471-2334, 1471-2334
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Shrnutí:Background The increased incidence of drug-resistant TB is a major challenge for effective TB control. Limited therapeutic options and poor treatment outcomes of DR-TB may increase drug-resistance rates. The objective of the study is to retrospectively compare MDR-TB and pre-XDR-TB treatment regimens and outcomes in two large TB reference centres in Italy from January 2000 to January 2015. Methods A retrospective, multicentre study was conducted at the Regional TB Reference Centre Villa Marelli Institute (Milan) and at the Reference Center for MDR-TB and HIV-TB, Eugenio Morelli Hospital (Sondalo). The supra-national Reference Laboratory in Milan performed DST. Inclusion criteria were: age ≥ 18 and culture-confirmed diagnosis of MDR- or pre-XDR TB. Chi-square or Fisher exact test was used to detect differences in the comparison between treatment outcomes, therapeutic regimens, and drug-resistances. Computations were performed with STATA 15. Results A total of 134 patients were selected. Median (IQR) age at admission was 33 (26–41) years and 90 patients (67.2%) were male. Pulmonary TB was diagnosed in 124 (92.5%) patients. MDR- and pre-XDR-TB cases were 91 (67.9%) and 43 (32.1%), respectively. The WHO shorter MDR-TB regimen could have been prescribed in 16/84 (19.1%) patients. Treatment success was not statistically different between MDR- and pre-XDR-TB (81.3% VS. 81.4%; P  = 0.99). Mortality in MDR-TB and pre-XDR-TB groups was 4.4 and 9.3%, respectively ( P  = 0.2). Median duration of treatment was 18 months and a total of 110 different regimens were administered. Exposure to linezolid, meropenem, and amikacin was associated with a better outcome in both groups ( P  = 0.001, P  < 0.001, and P  = 0.004, respectively). Conclusions Tailored treatment regimens based on DST results can achieve successful outcomes in patients with pre-XDR-TB.
Bibliografie:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 23
ISSN:1471-2334
1471-2334
DOI:10.1186/s12879-019-4211-0