Details

Autor(en) / Beteiligte

• BATTISTA MIGLIORI, Giovanni
• SOTGIU, Giovanni
• D'AMBROSIO, Lia
• SPANEVELLO, Antonio
• BAUER, Melissa
• CHAN, Edward D
• SCHAAF, H. Simon
• KESHAVJEE, Salmaan
• HOLTZ, Timothy H
• MENZIES, Dick
• GANDHI, Neel R
• FALZON, Dennis
• DERIEMER, Kathryn
• CENTIS, Rosella
• HOLLM-DELGADO, Maria-Graciela
• PALMERO, Domingo
• PEREZ-GUZMAN, Carlos
• VARGAS, Mario H

Titel

Drug resistance beyond extensively drug-resistant tuberculosis: individual patient data meta-analysis

Ist Teil von

• The European respiratory journal, 2013-07, Vol.42 (1), p.169-179

Ort / Verlag

Leeds: Maney

Erscheinungsjahr

2013

Quelle

MEDLINE

Beschreibungen/Notizen

• The broadest pattern of tuberculosis (TB) drug resistance for which a consensus definition exists is extensively drug-resistant (XDR)-TB. It is not known if additional drug resistance portends worsened patient outcomes. This study compares treatment outcomes of XDR-TB patients with and without additional resistance in order to explore the need for a new definition. Individual patient data on XDR-TB outcomes were included in a meta-analysis comparing outcomes between XDR alone and three nonmutually exclusive XDR-TB patient groups: XDR plus resistance to all the second-line injectables (sli) and capreomycin and kanamycin/amikacin (XDR+2sli) XDR plus resistance to second-line injectables and to more than one group 4 drug, i.e. ethionamide/protionamide, cycloserine/terizidone or para-aminosalicylic acid (XDR+sliG4) and XDR+sliG4 plus resistance to ethambutol and/or pyrazinamide (XDR+sliG4EZ). Of 405 XDR-TB cases, 301 were XDR alone, 68 XDR+2sli, 48 XDR+sliG4 and 42 XDR+sliG4EZ. In multivariate analysis, the odds of cure were significantly lower in XDR+2sli (adjusted OR 0.4, 95% CI 0.2-0.8) compared to XDR alone, while odds of failure and death were higher in all XDR patients with additional resistance (adjusted OR 2.6-2.8). Patients with additional resistance beyond XDR-TB showed poorer outcomes. Limitations in availability, accuracy and reproducibility of current drug susceptibility testing methods preclude the adoption of a useful definition beyond the one currently used for XDR-TB.