Comorbidities and treatment outcomes in multidrug resistant tuberculosis: a systematic review and meta-analysis

Samuels, Joel Philip; Sood, Aashna; Campbell, Jonathon R.; Khan, Faiz Ahmad; Johnston, James C.

doi:10.1038/s41598-018-23344-z

Cited by 68 publications

(64 citation statements)

References 81 publications

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“…This points to advanced HIV disease as a driver of higher risk of death in HIV-MDR-TB coinfected patients. This finding highlights the importance of providing timely HIV comprehensive care and treatment to HIV-MDRTB coinfected patients, and corroborates findings of a recent systematic review and meta-analysis [21] and other studies [22,30,31] that reported a high mortality rate in this patient population.…”

Section: Discussionsupporting

confidence: 90%

“…Contrary to expectations, our TB programme outperformed most programmes from well‐resourced settings that reported poor treatment outcome. The treatment success rate in our study was also significantly better than the results of a previous meta‐analysis reporting treatment success rates in the range of 62–63.48% . The treatment success rate of 90.5% in the group of patients treated with shorter MDR‐TB regimen is also greater than the 82% reported in a study evaluating the treatment outcome with the same regimen in nine African countries .…”

Section: Discussioncontrasting

confidence: 66%

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Highly successful treatment outcome of multidrug‐resistant and genetic diversity of multidrug‐resistant Mycobacterium tuberculosis strains in Rwanda

Muvunyi

Ngabonziza

Uwimana

et al. 2019

Tropical Med Int Health

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Objective To determine prevalent MDR‐TB genotypes and describe treatment outcome and bacteriology conversion in MDR‐TB patients. Methods Review of laboratory records of 173 MDR‐TB patients from all over Rwanda who initiated treatment under programmatic management of MDR‐TB (PMDT) between 2014 and 2015. Fifty available archived isolates were genotyped by mycobacterial interspersed repetitive units – variable number of tandem repeats (MIRU‐VNTR) genotyping. Result Of the 170 patients whose outcome was known, 114 (66.3%) were cured and 36 (21%) completed the treatment, giving a successful outcome (cured and completed) of 150 (87.3%) patients. Of 20 MDR‐TB patients with unfavourable treatment outcome, 18 died, one failed and one defaulted/stopped treatment. Of the 18 patients who died, 11 (61%) were HIV‐coinfected. The treatment outcome was successful for 93.9% among HIV negative and 81.8% among HIV‐coinfected patients (P = 0.02). Sputum smear conversion occurred in 3, 46, 57 and 78 patients before 2, 3, 4 and 6 months, respectively, with median time of sputum smear and culture conversion at 3 months. The 44 MDR‐TB isolates with MIRU‐VNTR result, showed high genetic diversity with low clustering rate (9.09%) and Uganda II being the most prevalent sub‐family lineage detected in 68.2% of isolates. Beijing family was the least common genotype detected (2.3%, 1 isolate). Conclusion The high success rates for MDR‐TB treatment achieved in Rwanda were comparable to outcomes observed in resource‐rich settings with HIV being an independent risk factor for poor treatment outcome. High genetic diversity and low clustering rate reported here suggest that reactivation of previous disease plays an important role in the transmission of MDR‐TB in Rwanda.

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Section: Discussionsupporting

confidence: 90%

Section: Discussioncontrasting

confidence: 66%

Highly successful treatment outcome of multidrug‐resistant and genetic diversity of multidrug‐resistant Mycobacterium tuberculosis strains in Rwanda

Muvunyi

Ngabonziza

Uwimana

et al. 2019

Tropical Med Int Health

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“…HIV infection was found to be associated with an unfavourable outcome and death. The values observed in our study are higher than 1.41 for unsuccessful treatment and 1.66 for death, as described in the meta-analysis that evaluated the outcomes of treatment of MDR-TB and XDR-TB among people living with and without HIV [18]. The same study also showed that unsuccessful treatment among people living with HIV is higher in low-income regions (RR 2.23, 95% CI 1, 60-3,11) than in high-income ones (RR 1.22, 95% CI 0.97-1.53).…”

Section: Discussionmentioning

confidence: 67%

“…The same study also showed that unsuccessful treatment among people living with HIV is higher in low-income regions (RR 2.23, 95% CI 1, 60-3,11) than in high-income ones (RR 1.22, 95% CI 0.97-1.53). This indicates that socio-environmental issues and lack of access to health care may increase the vulnerability of this group [18].…”

Section: Discussionmentioning

confidence: 99%

Predictive factors for unfavourable treatment in MDR-TB and XDR-TB patients in Rio de Janeiro State, Brazil, 2000-2016

Bhering

Duarte

Kritski

2019

Preprint

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22Setting: The State of Rio de Janeiro stands out as having the second highest 23 incidence and the highest mortality rate due to TB in Brazil. This study aims at 24 identifying the factors associated with the unfavourable treatment of MDR/XDR- 25 TB patients in that State. 26 Method: Data on 2269 MDR-TB cases reported in 2000-2016 in Rio de Janeiro 27 State were collected from the Tuberculosis Surveillance System. Bivariate and 28 multivariate logistic regressions were run to estimate the factors associated with 29 unfavourable outcomes (failure, default, and death) and, specifically, default and 30 death.31 Results: The proportion of unfavourable outcomes was 41.9% among MDR-TB 32 and 81.5% among XDR-TB. Having less than 8 years of schooling, and being an 33 Afro-Brazilian, under 40 years old and drug user were associated with 34 unfavourable outcome and default. Bilateral disease, HIV positive, and 35 comorbidities were associated with death. XDR-TB cases had a 4.7-fold higher 36 odds of an unfavourable outcome, with 29.3% of such cases being in the first 37 treatment for multidrug resistance.38 Conclusion: About 30% of XDR-TB cases may have occurred by primary 39 transmission. The high rates of failure and death in this category reflect the 40 limitation of treatment options. This highlights the urgency to incorporate new 41 drugs in the treatment.42 43 3 44 45 Resistant multidrug TB (MDR-TB) and extensively resistant TB (TB-XDR) are a 46 source of a public-health crises worldwide. The treatment is longer, requires more 47 expensive and toxic drugs than TB with drug-sensitive bacilli [1,2]. 48 In Brazil the incidence of TB decreased from 39 per 100 thousand inhabitants in 49 2008 to 33.5 in 2017. The mortality rate went from 2.6 per 100 thousand 50 inhabitants in 2007 to 2.2 in 2016 [3]. 51 However, the State of Rio de Janeiro (henceforth RJ) stands out as having the 52 second highest incidence in the country and the highest mortality rate due to TB, 53 which were 63.5 in 2017 and 4.4 per 100 thousand inhabitants in 2016, 54 respectively. 3 Given that this state is one of the country's most developed, it is 55 relevant to investigate the reasons behind its poor performance [4]. 56 That said, this study aims to identify factors associated with the unfavourable 57 treatment of patients with MDR/XDR-TB in RJ, also considering default and death 58 as specific outcomes. 59 Materials and methods 60 Data and sample 61This was an observational retrospective cohort study based on secondary data. 62 The cohort was extracted from the Special Tuberculosis Treatment System 63 (SITETB). SITETB is an electronic information system of Brazil's Health Ministry, 64 used for the notification and follow-up of all TB cases requiring special treatments 65 by patients unable to use the standard TB regimen (2RHZE/4RH) [5]. 4 66 This study used surveillance data, with no possibility of linking patient records to 67 patient personal data, so ethical approval was considered unnecessary. 68 Statistical methods 69 Treatment outcomes...

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“…Accordingly, the literature findings reveal HIV as the greatest comorbidity that elevates the risk of MDR-TB to many-fold [4]. The other comorbidities including alcohol abuse, chronic kidney disease, and diabetes mellitus deteriorate the therapeutic outcomes of MDR-TB patients in many clinical scenarios [22]. The clinical literature also reveals 14.1% TB patients affected with single or multiple drug resistance [18].…”

Section: Causative Factors Of Mdr-tbmentioning

confidence: 99%

Multidrug-Resistant Tuberculosis (MDR-TB): Epidemiology, Causes, Pathophysiology, Diagnostic Approaches, Preventive Interventions, and Treatment Challenges/Opportunities – (An Evidence-Based Narrative Literature Review)

Rahman¹

2019

TIJCR

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Background: MDR-TB (Multidrug-resistant tuberculosis) reportedly proves to be the greatest public health issue on a global scale. The mutation tendency of Mycobacterium tuberculosis substantially elevates its resistance against the recommended pharmacotherapeutic interventions. Limited information on the MDR-TB diagnostic approaches and treatment options is primarily responsible for its extensive progression across resource-limited regions. The frequently reported adverse effects of the standard therapies barricade their long-term use by the MDR-TB patients.Aim: The presented narrative review attempts to consolidate and strengthen the clinical evidence for improving the MDR-TB diagnosis and treatment decisions in health care settings.Methods: The author performed an evidence-based analysis of the causative factors, pathophysiology, diagnostic techniques, and treatment options/challenges for MDR-TB through the systematic exploration of databases including Google Scholar, PubMed/Medline, and Cochrane Library. The utilization of these databases was effectively undertaken to explore the peer-reviewed MDR-TB-related articles based on meta-analysis, systematic review, retrospective study, randomized controlled trial, and narrative literature reviews.Findings: The study findings revealed MDR-TB epidemiology, etiology, diagnostic approaches, preventive measures, pathogenesis, treatment adversities, and therapeutic potential in the context of controlling the prevalence of drug-resistant tuberculosis and related comorbidities.Conclusion: The study findings advocate the need for improving the overall MDR-TB investigation and treatment process to control the elevated prevalence of MDR-TB among the suspected patients. The study outcomes advocate the requirement of multidisciplinary coordination between clinicians and researchers to effectively improve the medical decision-making quality for enhancing the therapeutic outcomes of MDR-TB patients.

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Comorbidities and treatment outcomes in multidrug resistant tuberculosis: a systematic review and meta-analysis

Cited by 68 publications

References 81 publications

Highly successful treatment outcome of multidrug‐resistant and genetic diversity of multidrug‐resistant Mycobacterium tuberculosis strains in Rwanda

Highly successful treatment outcome of multidrug‐resistant and genetic diversity of multidrug‐resistant Mycobacterium tuberculosis strains in Rwanda

Predictive factors for unfavourable treatment in MDR-TB and XDR-TB patients in Rio de Janeiro State, Brazil, 2000-2016

Multidrug-Resistant Tuberculosis (MDR-TB): Epidemiology, Causes, Pathophysiology, Diagnostic Approaches, Preventive Interventions, and Treatment Challenges/Opportunities – (An Evidence-Based Narrative Literature Review)

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