Screening outcomes from patients with suspected multidrug-resistant tuberculosis: lessons learned in the Philippines

Gler, Maria Tarcela; Guilatco, Ruffy; Guray, C V; Tupasi, Thelma E.

doi:10.5588/ijtld.12.0038

Cited by 6 publications

(6 citation statements)

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“…This was in concordance with the result of another study in Philippines that found MDR as the most frequent resistance pattern among TB patients (42). We found that 3 (3.2% of all patients, 9.3% of MDR patients and 20% of INH resistant cases) had KatG or InhA gene mutation and 9 (9.7% of all patients, 28% of MDR patients and 60% of INH resistant cases) exhibited mutation in both genes by Allele Specific PCR in this study.…”

Section: Discussionsupporting

confidence: 92%

Mycobacterium Strain and Type of Resistance in Pulmonary Tuberculosis Patients: A Missed Link in Iran’s National Tuberculosis Plan

et al. 2015

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Background: The Incidence of multi-drug resistant tuberculosis (MDR-TB) is constantly increasing.Objectives: This study aimed to clarify an important missed link in Iran's national TB plan. Patients and Methods: Through a 9-month period, all pulmonary TB patients diagnosed based on the national TB protocol, in Shiraz TB center, were selected and culture of TB colonies, drug susceptibility testing (DST), polymerase chain reaction (PCR) for detection of IS6110 gene, Isoniazid (INH) and Rifampin (RIF) tuberculosis resistance were done to collect data. Data were analyzed using SPSS. Conclusions:Findings of the present study show that 4 out of five new cases of pulmonary TB patients who were diagnosed based on the national TB protocol (clinical symptoms and acid fast bacilli staining) had IS6110 gene (MTB, Mycobactrium TB) and at least one-fifth of this group had A kind of Drug Resistant TB. Therefore, by using PCR ,as a complementary test, it could be possible to start 1st line anti-TB drugs for only MTB cases (up to 77% of the patients) and 2nd line drugs for MDR cases (15% of cases). This policy aims to achieve safety and better outcome for patients while saving human and financial resources in health care system.

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Section: Discussionsupporting

confidence: 92%

Mycobacterium Strain and Type of Resistance in Pulmonary Tuberculosis Patients: A Missed Link in Iran’s National Tuberculosis Plan

et al. 2015

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“…In our study, DR and MDR TB cases had higher proportions changing or initiating treatment after DST results and higher favorable outcomes, similar to those described (44.0%–57.0%) by Yacobson [ 15 ] and Gler [ 25 ].…”

Section: Discussionsupporting

confidence: 89%

“…Probably, physicians started anti-TB medication for suspected drug resistant TB before the results of susceptibility testing, due to previous delays experienced in the release of such results by phenotypic tests. Nevertheless, the median release time of DST results was 69.5 days, similar to (52–70 days) observed by Hannarah [ 10 ], Tukvadze et al [ 11 ] and Yadava et al [ 14 ] and lower than described (106–133 days) by Boheme et al [ 12 ], Shin et al [ 24 ], and Gler et al [ 25 ].…”

Section: Discussionsupporting

confidence: 87%

“…The median time from first admission to the Reference Unit to start the appropriate treatment for DR-TB suspects was 1.0 day, which is lower than that described (67–133 days) by Hannarah et al [ 10 ], Jacobson et al [ 15 ], Joh et al [ 26 ], Shin [ 24 ] and Gler [ 25 ]. This result may be different as the other studies did not describe the relationship with empirical treatment and the change of treatment after DST results were released.…”

Section: Discussionmentioning

confidence: 63%

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Outcomes from patients with presumed drug resistant tuberculosis in five reference centers in Brazil

et al. 2017

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BackgroundThe implementation of rapid drug susceptibility testing (DST) is a current global priority for TB control. However, data are scarce on patient-relevant outcomes for presumptive diagnosis of drug-resistant tuberculosis (pDR-TB) evaluated under field conditions in high burden countries.MethodsObservational study of pDR-TB patients referred by primary and secondary health units. TB reference centers addressing DR-TB in five cities in Brazil. Patients age 18 years and older were eligible if pDR-TB, culture positive results for Mycobacterium tuberculosis and, if no prior DST results from another laboratory were used by a physician to start anti-TB treatment. The outcome measures were median time from triage to initiating appropriate anti-TB treatment, empirical treatment and, the treatment outcomes.ResultsBetween February,16th, 2011 and February, 15th, 2012, among 175 pDR TB cases, 110 (63.0%) confirmed TB cases with DST results were enrolled. Among study participants, 72 (65.5%) were male and 62 (56.4%) aged 26 to 45 years. At triage, empirical treatment was given to 106 (96.0%) subjects. Among those, 85 were treated with first line drugs and 21 with second line. Median time for DST results was 69.5 [interquartile - IQR: 35.7–111.0] days and, for initiating appropriate anti-TB treatment, the median time was 1.0 (IQR: 0–41.2) days. Among 95 patients that were followed-up during the first 6 month period, 24 (25.3%; IC: 17.5%–34.9%) changed or initiated the treatment after DST results: 16/29 MDRTB, 5/21 DR-TB and 3/45 DS-TB cases. Comparing the treatment outcome to DS-TB cases, MDRTB had higher proportions changing or initiating treatment after DST results (p = 0.01) and favorable outcomes (p = 0.07).ConclusionsThis study shows a high rate of empirical treatment and long delay for DST results. Strategies to speed up the detection and early treatment of drug resistant TB should be prioritized.

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“…Application of rapid DST techniques, including providing finances and reagent supplies, may be useful to reduce diagnostic delays and expedite treatment for drug‐resistant TB, but the methods should be piloted before wide application . GeneXpert MTB/RIF, line probe assays and Genechip are being evaluated by China's National Reference Laboratory, but are yet to be incorporated into the current diagnostic algorithms.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic and treatment delays of multidrug‐resistant tuberculosis before initiating treatment: a cross‐sectional study

Zhang

Yin

et al. 2015

Tropical Med Int Health

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Abstractobjective Shandong Province has implemented the standardised treatment of multidrug-resistant tuberculosis (MDR-TB) supported by the Global Fund. The study aimed to understand the managements and delays of patients with MDR-TB before initiating their treatments.methods All patients with MDR-TB who had completed intensive phase treatment from January 2010 to May 2012 were interviewed using a structured questionnaire. Delays and treatments were analysed. Diagnosis delay is defined as the period between having sputum smear results and drug susceptibility test (DST) results. Treatment delay was defined as starting MDR-TB treatment more than 2 days after receiving the diagnosis of MDR-TB. Total delay is the sum of diagnosis delay and treatment delay.results In total, 110 patients with MDR-TB participated in the study. Median delay for diagnosis was 102 days. Over 80% of patients had a diagnosis delay longer than 90 days. MDR-TB treatments commenced after a median of 9 days after DST results, and over 37% of the patients with MDR-TB experienced treatment delays. Chronic cases or patients with indifferent attitude had significantly longer treatment delay than other groups (P = 0.03 and 0.03, respectively). During their delays, of 44 patients with retreatment failures, 12 (27.3%) were treated through adding single second line drugs (SLDs) to first-line regimens, and 25 (56.8%) were treated with first-line drugs. A high proportion of initial treatment failure/relapsed/returned cases (37%) and new cases (43%) were administered with SLDs.

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Screening outcomes from patients with suspected multidrug-resistant tuberculosis: lessons learned in the Philippines

Cited by 6 publications

References 0 publications

Mycobacterium Strain and Type of Resistance in Pulmonary Tuberculosis Patients: A Missed Link in Iran’s National Tuberculosis Plan

Mycobacterium Strain and Type of Resistance in Pulmonary Tuberculosis Patients: A Missed Link in Iran’s National Tuberculosis Plan

Outcomes from patients with presumed drug resistant tuberculosis in five reference centers in Brazil

Diagnostic and treatment delays of multidrug‐resistant tuberculosis before initiating treatment: a cross‐sectional study

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