Clinical Management of Multidrug-Resistant Tuberculosis in 16 European Countries

Günther, Gunar; Leth, Frank van; Alexandru, Sofia; Altet, Neus; Avsar, Korkut; Bang, Didi; Bărbuţă, R; Bothamley, Graham; Ciobanu, Ana; Crudu, Valeriu; Danilovitš, Manfred; Dedicoat, Martin; Duarte, Raquel; Gualano, Gina; Kunst, Heinke; Lange, Wiel de; Leimane, Vaira; McLaughlin, Anne-Marie; Magis-Escurra, Cécile; Muylle, Inge; Polcová, Veronika; Popa, Cristina; Rumetshofer, Rudolf; Skrahina, Alena; Solodovnikova, Varvara; Spînu, Victor; Tiberi, Simon; Viiklepp, Piret; Lange, Christoph; Tbnet, for

doi:10.1164/rccm.201710-2141oc

Cited by 28 publications

(18 citation statements)

References 20 publications

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“…We found high rates of resistance to pyrazinamide (55.0%) and ethambutol (63.1%) in our MDR-TB cohort, as also reported by other studies [17,18]. This may reflect the fact that the majority of MDR-TB patients (94.3%) already had exposure to first line anti-TB drugs and might have developed resistance to pyrazinamide and ethambutol during previous treatment.…”

Section: Discussionsupporting

confidence: 88%

Risk factors for poor treatment outcomes of 2266 multidrug-resistant tuberculosis cases in Ho Chi Minh City: a retrospective study

et al. 2020

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Background: Multidrug resistant tuberculosis (MDR-TB) remains a serious public health problem with poor treatment outcomes. Predictors of poor outcomes vary in different regions. Vietnam is among the top 30 high burden of MDR-TB countries. We describe demographic characteristics and identify risk factors for poor outcome among patients with MDR-TB in Ho Chi Minh City (HCMC), the most populous city in Vietnam. Methods: This retrospective study included 2266 patients who initiated MDR-TB treatment between 2011 and 2015 in HCMC. Treatment outcomes were available for 2240 patients. Data was collected from standardized paper-based treatment cards and electronic records. A Kruskal Wallis test was used to assess changes in median age and body mass index (BMI) over time, and a Wilcoxon test was used to compare the median BMI of patients with and without diabetes mellitus. Chi squared test was used to compare categorical variables. Multivariate logistic regression with multiple imputation for missing data was used to identify risk factors for poor outcomes. Statistical analysis was performed using R program. Results: Among 2266 eligible cases, 60.2% had failed on a category I or II treatment regimen, 57.7% were underweight, 30.2% had diabetes mellitus and 9.6% were HIV positive. The notification rate increased 24.7% from 2011 to 2015. The treatment success rate was 73.3%. Risk factors for poor treatment outcome included HIV co-infection (adjusted odds ratio (aOR): 2.94), advanced age (aOR: 1.45 for every increase of 5 years for patients 60 years or older), having history of MDR-TB treatment (aOR: 5.53), sputum smear grade scanty or 1+ (aOR: 1.47), smear grade 2+ or 3+ (aOR: 2.06), low BMI (aOR: 0.83 for every increase of 1 kg/m2 of BMI for patients with BMI < 21). Conclusion: The number of patients diagnosed with MDR-TB in HCMC increased by almost a quarter between 2011 and 2015. Patients with HIV, high smear grade, malnutrition or a history of previous MDR-TB treatment are at greatest risk of poor treatment outcome.

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Section: Discussionsupporting

confidence: 88%

Risk factors for poor treatment outcomes of 2266 multidrug-resistant tuberculosis cases in Ho Chi Minh City: a retrospective study

et al. 2020

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“…We found high rates of resistance to pyrazinamide (55.0%) and ethambutol (63.1%) in our MDR-TB cohort, as also reported by other studies (17) (18). This may reflect the fact that the majority of MDR-TB patients (94.3%) already had exposure to first line anti-TB drugs and might have developed resistance to pyrazinamide and ethambutol during previous treatment.…”

Section: Discussionsupporting

confidence: 88%

Risk factors for poor treatment outcomes of 2,266 multidrug-resistant tuberculosis cases in Ho Chi Minh City: a retrospective study

Van

Phu

Vinh

et al. 2020

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Background: Multidrug resistant tuberculosis (MDR-TB) remains a serious public health problem with poor treatment outcomes. Predictors of poor outcomes vary in different regions. Vietnam is among the top 30 high burden of MDR-TB countries. We describe demographic characteristics and identify risk factors for poor outcome among patients with MDR-TB in Ho Chi Minh City (HCMC), the most populous city in Vietnam.Methods: This retrospective study included 2,266 patients who initiated MDR-TB treatment between 2011-2015 in HCMC. Treatment outcomes were available for 2,240 patients. Data was collected from standardized paper-based treatment cards and electronic records. A Kruskal Wallis test was used to assess changes in median age and body mass index (BMI) over time, and a Wilcoxon test was used to compare the median BMI of patients with and without diabetes mellitus. Chi squared test was used to compare categorical variables. Multivariate logistic regression with multiple imputation for missing data was used to identify risk factors for poor outcomes. Statistical analysis was performed using R program.Results: Among 2,266 eligible cases, 60.2% had failed on a category I or II treatment regimen, 57.7% were underweight, 30.2% had diabetes mellitus and 9.6% were HIV positive. The notification rate increased 24.7% from 2011-2015. The treatment success rate was 73.3%. Risk factors for poor treatment outcome included HIV co-infection (adjusted odds ratio (aOR): 2.94), advanced age (aOR: 1.45 for every increase of 5 years for patients 60 years or older), having history of MDR-TB treatment (aOR: 5.53), sputum smear grade scanty or 1+ (aOR: 1.47), smear grade 2+ or 3+ (aOR: 2.06), low BMI (aOR: 0.83 for every increase of 1kg/m2 of BMI for patients with BMI<21).Conclusion: The number of patients diagnosed with MDR-TB in HCMC increased by almost a quarter between 2011-2015. Patients with HIV, high smear grade, malnutrition or a history of previous MDR-TB treatment are at greatest risk of poor treatment outcome.

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“…We found high rates of resistance to pyrazinamide (55.0%) and ethambutol (63.0%) in our MDR-TB cohort, as reported by other studies [14] [15]. This may reflect the fact that the majority of MDR-TB patients (94.3%) already had exposure to first line anti-TB drugs and might have developed resistance to pyrazinamide and ethambutol during previous treatment.…”

Section: Discussionsupporting

confidence: 85%

Multidrug-resistant tuberculosis in Ho Chi Minh City: a retrospective study of 2,267 cases from 2011 to 2015

Van

Phu

Vinh

et al. 2019

Preprint

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Background Multidrug resistant tuberculosis (MDR-TB) remains a serious public health problem with poor treatment outcome. Predictors of poor outcomes vary in different health-care settings. Vietnam is among the 30 countries with high burden of MDR-TB. We aim to describe demographic characteristics and identify risk factors for poor outcome of MDR-TB in Ho Chi Minh City (HCMC), the most populous city in Vietnam. Methods This retrospective study included 2,267 patients who initiated MDR-TB treatment from 2011 to 2015 in HCMC. Treatment outcomes were available in 2,241 patients. Data was collected from standardized paper-based treatment cards and electronic records. Statistical analysis was performed using R program. Results Among 2,267 eligible cases, 60.2% were failure of category I or II regimen, 57.7% were underweight, 30.2% had diabetes mellitus and 9.6% were HIV positive. Notification rate increased 24.7% from 2011 to 2015.Treatment success rate was 73.3%. Risk factors for poor treatment outcome included HIV co-infection (odds ratio (OR): 2.92), advanced age (OR: 1.47 for every increase of 5 years for patients older than 60), having history of MDR-TB treatment (OR: 5.65), sputum smear grade scanty and 1+ (OR: 1.48), smear grade 2+ or 3+ (OR: 2.07), low BMI (OR: 0.84 for every increase of 1kg/m2 of BMI for patients with BMI<21). Conclusion Our study describes the increasing burden of MDR-TB in HCMC and the need for better drug resistance screening for all TB patients. Patients with HIV, high smear grade, malnutrition and history of previous MDR-TB treatment should receive additional care.

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Clinical Management of Multidrug-Resistant Tuberculosis in 16 European Countries

Abstract: Conventional standard MDR-TB treatment regimens resulted in a higher frequency of failure compared with individualized treatments. Overall, cure from MDR-TB is substantially more frequent than previously anticipated, and poorly reflected by World Health Organization outcome definitions.

Cited by 28 publications

References 20 publications

Risk factors for poor treatment outcomes of 2266 multidrug-resistant tuberculosis cases in Ho Chi Minh City: a retrospective study

Risk factors for poor treatment outcomes of 2266 multidrug-resistant tuberculosis cases in Ho Chi Minh City: a retrospective study

Risk factors for poor treatment outcomes of 2,266 multidrug-resistant tuberculosis cases in Ho Chi Minh City: a retrospective study

Multidrug-resistant tuberculosis in Ho Chi Minh City: a retrospective study of 2,267 cases from 2011 to 2015

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