Prevalence, Risk Factors, and Treatment Outcomes of Isoniazid- and Rifampicin- Mono-Resistant Pulmonary Tuberculosis in Lima, Peru

Isoniazid and rifampicin are the two most efficacious first-line agents for tuberculosis (TB) treatment. We assessed the prevalence of isoniazid and rifampicin mono-resistance, associated risk factors, and the association of mono-resistance on treatment outcomes. A prospective, observational cohort...

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Veröffentlicht in:PloS one Jg. 11; H. 4; S. e0152933
Hauptverfasser: Villegas, Leonela, Otero, Larissa, Sterling, Timothy R., Huaman, Moises A., Van der Stuyft, Patrick, Gotuzzo, Eduardo, Seas, Carlos
Format: Journal Article
Sprache:Englisch
Veröffentlicht: United States Public Library of Science 05.04.2016
Public Library of Science (PLoS)
Schlagworte:
Adult
Adults
Alcoholism
Analysis
Antibiotics
Antitubercular Agents - therapeutic use
Biology and Life Sciences
Clinical outcomes
Confidence intervals
Dosage and administration
Drug abuse
Drug resistance
Drug Resistance, Bacterial
Drug therapy
Drugs
Epidemiology
Female
Health care facilities
Human immunodeficiency virus
Humans
Humboldt, Alexander von (1769-1859)
Isoniazid
Isoniazid - therapeutic use
Laboratories
Male
Medicine
Medicine and Health Sciences
Mycobacterium
Mycobacterium tuberculosis
Observational studies
Patient outcomes
Patients
Peru - epidemiology
Prevalence
Public health
Pulmonary tuberculosis
Regression models
Resistance factors
Rifampin
Rifampin - therapeutic use
Risk analysis
Risk Factors
Smear
Sputum
Statistical analysis
Studies
Substance abuse treatment
Systematic review
Treatment outcome
Tuberculosis
Tuberculosis, Pulmonary - drug therapy
Tuberculosis, Pulmonary - epidemiology
Peru
South Africa
Belgium
United States > US
Lima Peru
Nashville Tennessee
ISSN:1932-6203, 1932-6203
Online-Zugang:Volltext
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Zusammenfassung:Isoniazid and rifampicin are the two most efficacious first-line agents for tuberculosis (TB) treatment. We assessed the prevalence of isoniazid and rifampicin mono-resistance, associated risk factors, and the association of mono-resistance on treatment outcomes. A prospective, observational cohort study enrolled adults with a first episode of smear-positive pulmonary TB from 34 health facilities in a northern district of Lima, Peru, from March 2010 through December 2011. Participants were interviewed and a sputum sample was cultured on Löwenstein-Jensen (LJ) media. Drug susceptibility testing was performed using the proportion method. Medication regimens were documented for each patient. Our primary outcomes were treatment outcome at the end of treatment. The secondary outcome included recurrent episodes among cured patients within two years after completion of the treatment. Of 1292 patients enrolled, 1039 (80%) were culture-positive. From this subpopulation, isoniazid mono-resistance was present in 85 (8%) patients and rifampicin mono-resistance was present in 24 (2%) patients. In the multivariate logistic regression model, isoniazid mono-resistance was associated with illicit drug use (adjusted odds ratio (aOR) = 2.10; 95% confidence interval (CI): 1.1-4.1), and rifampicin mono-resistance was associated with HIV infection (aOR = 9.43; 95%CI: 1.9-47.8). Isoniazid mono-resistant patients had a higher risk of poor treatment outcomes including treatment failure (2/85, 2%, p-value<0.01) and death (4/85, 5%, p<0.02). Rifampicin mono-resistant patients had a higher risk of death (2/24, 8%, p<0.01). A high prevalence of isoniazid and rifampicin mono-resistance was found among TB patients in our low HIV burden setting which were similar to regions with high HIV burden. Patients with isoniazid and rifampicin mono-resistance had an increased risk of poor treatment outcomes.
Bibliographie:ObjectType-Article-1
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Competing Interests: The authors have declared that no competing interests exist.
These authors also contributed equally to this work.
Conceived and designed the experiments: LV LO MAH TRS PVDS EG CS. Performed the experiments: LV LO PVDS CS. Analyzed the data: LV LO TRS MAH. Contributed reagents/materials/analysis tools: LV LO MAH TRS PVDS EG CS. Wrote the paper: LV LO MAH TRS PVDS EG CS.
Current Address: Division of Infectious Diseases, Vanderbilt University School of Medicine, A2209 Medical Center North, Nashville, TN, United States of America
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0152933