Pyrazinamide Resistance, Mycobacterium tuberculosis Lineage and Treatment Outcomes in San Francisco, California

Pyrazinamide (PZA) is a first line agent for the treatment of active tuberculosis. PZA is also considered a potent companion drug for newer regimens under development. There are limited data on the demographic, clinical, and pathogen characteristics of PZA resistant tuberculosis. Using a retrospecti...

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Vydané v:PloS one Ročník 9; číslo 4; s. e95645
Hlavní autori: Budzik, Jonathan M., Jarlsberg, Leah G., Higashi, Julie, Grinsdale, Jennifer, Hopewell, Phil C., Kato-Maeda, Midori, Nahid, Payam
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: United States Public Library of Science 01.04.2014
Public Library of Science (PLoS)
Predmet:
Antibiotics
Antitubercular Agents - therapeutic use
Biology and Life Sciences
Clinical outcomes
Comparative analysis
Critical care
Data processing
Demographics
Disease
Disease resistance
Drug resistance
Drug resistance in microorganisms
Drug therapy
Epidemiology
Health surveillance
Hospitals
Humans
Infections
Medical diagnosis
Medicine
Medicine and Health Sciences
Microbial Sensitivity Tests
Mycobacterium bovis
Mycobacterium tuberculosis
Mycobacterium tuberculosis - drug effects
Mycobacterium tuberculosis - pathogenicity
Patient outcomes
Patients
Pharmaceutical research
Public health
Pyrazinamide
Pyrazinamide - pharmacology
Pyrazinamide - therapeutic use
Retrospective Studies
San Francisco
Statistical analysis
Treatment Outcome
Tuberculosis
Tuberculosis - drug therapy
Tuberculosis, Multidrug-Resistant - drug therapy
San Francisco
California
Canada
San Francisco California
United States > US
Quebec Canada
ISSN:1932-6203, 1932-6203
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Shrnutí:Pyrazinamide (PZA) is a first line agent for the treatment of active tuberculosis. PZA is also considered a potent companion drug for newer regimens under development. There are limited data on the demographic, clinical, and pathogen characteristics of PZA resistant tuberculosis. Using a retrospective cohort study design, we evaluated all PZA resistant M. tuberculosis (M.tb) and M. bovis cases reported in San Francisco from 1991 to 2011. Demographic, clinical, and molecular data were analyzed. M.tb lineage was determined for all PZA resistant strains and compared to PZA susceptible strains. PZA resistance was identified in 1.8% (50 of 2,842) of mycobacterial isolates tested, corresponding to a case rate of 0.3 per 100,000 in the population. Monoresistant PZA infection was associated with the Hispanic population ([OR], 6.3; 95% [CI], 1.97-20.16) and 48% of cases were due to M. bovis. Infection with monoresistant PZA was also associated with extrapulmonary disease ([OR], 6.0; 95% [CI], 2.70-13.26). There was no statistically significant difference between treatment failure and mortality rates in patients infected with PZA monoresistance compared to pansusceptible controls (4% vs. 8%, p = 0.51), or those with PZA and MDR resistance (PZA-MDR) compared to MDR controls (18% vs. 29%, p = 0.40). PZA resistance was not associated with M.tb lineage. Across two decades of comprehensive epidemiologic data on tuberculosis in San Francisco County, PZA resistance was uncommon. PZA resistance caused predominantly extrapulmonary disease and was more common in Hispanics compared to other ethnicities, with nearly half the cases attributed to M. bovis. No association was found between PZA monoresistance and M.tb lineage. Treatment outcomes were not adversely influenced by the presence of PZA resistance.
Bibliografia:ObjectType-Article-1
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Conceived and designed the experiments: JMB LGJ PHC MKM PN. Performed the experiments: JMB JH JG MKM. Analyzed the data: JMB LGJ MKM PN. Contributed reagents/materials/analysis tools: JMB LGJ JH JG PHC MKM PN. Wrote the paper: JMB LGJ MKM PN.
Competing Interests: The authors have declared that no competing interests exist.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0095645