Details

Autor(en) / Beteiligte

• Seddon, James A
• Visser, Douwe H
• Bartens, Margaux
• Jordaan, Annemie M
• Victor, Thomas C
• van Furth, A Marceline
• Schoeman, Johan F
• Schaaf, H Simon

Titel

Impact of Drug Resistance on Clinical Outcome in Children With Tuberculous Meningitis

Ist Teil von

• The Pediatric infectious disease journal, 2012-07, Vol.31 (7), p.711-716

Ort / Verlag

Hagerstown, MD: Lippincott Williams & Wilkins, Inc

Erscheinungsjahr

2012

Link zum Volltext

Quelle

MEDLINE

Beschreibungen/Notizen

• BACKGROUND:Tuberculous meningitis (TBM) is associated with delayed diagnosis and poor outcome in children. This study investigated the impact of drug resistance on clinical outcome in children with TBM. METHODS:All children (0–13 years) were included if admitted to Tygerberg Children’s Hospital, Cape Town, South Africa, from January 2003 to April 2009 with a diagnosis of either confirmed TBM, or probable TBM with mycobacterial isolation from a site other than cerebrospinal fluid. Mycobacterial samples underwent drug susceptibility testing to rifampin and isoniazid. Children were treated with isoniazid, rifampin, pyrazinamide and ethionamide according to local guidelines. RESULTS:One hundred twenty-three children were included; 13% (16 of 123) had any form of drug resistance, and 4% (5 of 123) had multidrug-resistant tuberculosis. Time from start of symptoms to appropriate treatment was longer in children with any drug resistance (median31 days versus 9 days; P = 0.001). In multivariable analysis, young age (P = 0.013) and multidrug-resistant tuberculosis (adjusted odds ratio12.4 [95% confidence interval1.17–132.3]; P = 0.037) remained risk factors for unfavorable outcome, and multidrug-resistant tuberculosis remained a risk for death (adjusted odds ratio63.9 [95% confidence interval4.84–843.2]; P = 0.002). We did not detect any difference in outcome between those with isolates resistant to only isoniazid and those with fully susceptible strains (adjusted odds ratio0.22 [confidence interval0.03–1.87]; P = 0.17). CONCLUSION:Multidrug-resistant TBM in children has poor clinical outcome and is associated with death. We did not find any difference in the outcomes between children with isoniazid monoresistant TBM and those with drug-susceptible TBM. One explanation could be the local treatment regimen. Further investigation of this regimen is indicated.