Treatment of extensively drug-resistant tuberculosis in Tomsk, Russia: a retrospective cohort study

Keshavjee, Salmaan; Gelmanova, Irina; Farmer, Paul; Mishustin, Sergey P.; Стрелис, А. К.; Andreev, Yevgeny G.; Pasechnikov, Alexander; Atwood, Sidney; Mukherjee, Joia S.; Rich, Michael; Furin, Jennifer; Nardell, Edward A.; Kim, Jim Y.; Shin, Sonya

doi:10.1016/s0140-6736(08)61204-0

Cited by 143 publications

(123 citation statements)

References 24 publications

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“…Defaulting of TB treatment seems to be a global phenomenon with rates of over 15% in several countries, including Korea (32%) (23), Taiwan (29%) (24), Russia (20%) (25), South Africa (29%) (26), Argentina (20%) (27), and Peru (19%) (28). The treatment default rate in this study (17%) was higher than that revealed by a study in Spain (16%) (29) and similar to that reported by a study in Italy (30).…”

Section: Discussionmentioning

confidence: 99%

Treatment Outcomes of Patients with Multidrug-Resistant Tuberculosis (MDR- TB) Compared with Non-MDR-TB Infections in Peninsular Malaysia

Elmi

Hasan

Abdullah

et al. 2016

MJMS

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Background: Treating patients with multidrug-resistant tuberculosis (MDR-TB) strains is more complicated, complex, toxic, expensive, than treating patients with susceptible TB strains. This study aims to compare the treatment outcomes and potential factors associated between patients with MDR-TB and non MDR TB infections in peninsular Malaysia.Methods: This study was a retrospective cohort study. Data were collected from the medical records of all registered MDR-TB patients and Non-MDR-TB patients at five TB hospitals in peninsular Malaysia from January 2010 to January 2014.Results: A total of 314 subjects were studied, including 105 MDR-TB cases and 209 non-MDR-TB. After TB treatment, 24.8% of the MDR-TB patients and 17.7% of non MDR TB relapsed; 17.1% of the MDR-TB patients and 16.3% of non MDR TB defaulted from TB treatment. A significant difference seen in treatment success rate 17.1% for MDR-TB; 63.1% for non MDR TB (P < 0.001)). Mortality rate were 8.9% for MDR-TB; 13.2% for non MDR TB. Multivariable analysis showed the potential factors associated with poor treatment outcomes were presence of HIV infection (AOR, 1.09; 95%CI: 1.05, 1.75; P = 0.001) and previous TB treatment (AOR, 4.87; 95%CI: 2.84, 8.38; P = 0.001).Conclusion: This study revealed that the treatment success rate in patients with non MDR TB infection was higher than MDR-TB. Unsuccessful treatment was seen in MDR-TB associated with potential factors such as history of TB treatment, and presence of HIV infection.

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Section: Discussionmentioning

confidence: 99%

Treatment Outcomes of Patients with Multidrug-Resistant Tuberculosis (MDR- TB) Compared with Non-MDR-TB Infections in Peninsular Malaysia

Elmi

Hasan

Abdullah

et al. 2016

MJMS

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“…Regardless of the mechanism of access, a subset of individuals inevitably will fail to respond to MDR-TB therapy, and, in the process, may acquire additional resistance to second-line drugs (2)(3)(4). Extensively drug-resistant (XDR) TB-defined as MDR-TB with additional resistance to the fluoroquinolones and a second-line injectable-is the result of this sequential mutationselection process, and compromises the effectiveness of even the most tailored individualized regimens (5)(6)(7).…”

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confidence: 99%

Development of Extensively Drug-resistant Tuberculosis during Multidrug-resistant Tuberculosis Treatment

Shin¹,

Keshavjee²,

Gelmanova³

et al. 2010

Am J Respir Crit Care Med

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Rationale: Extensively drug-resistant (XDR) tuberculosis (TB) may arise in individuals on treatment for multidrug-resistant (MDR) TB. Preventing this amplification of resistance will likely improve clinical outcomes and delay the secondary spread of XDR-TB. Objectives: To measure the proportion of individuals that develops XDR-TB during the course of MDR-TB treatment, and to identify those factors associated with the development of XDR. Methods: We performed a retrospective analysis of 608 consecutive patients with documented MDR-TB who were started on MDR-TB treatment between September 10, 2000 and November 1, 2004 in the Tomsk Oblast TB Treatment Services in Western Siberia, Russian Federation. Measurements and Main Results: A total of 6% of patients were observed to develop XDR-TB while on MDR-TB treatment. These patients were significantly less likely to be cured or to complete treatment. Using Cox proportional hazard models, we found that the presence of bilateral and cavitary lesions was associated with a greater than threefold increase in hazard (adjusted hazard ratio [HR], 3.47; 95% confidence interval [CI], 1.32-9.14). Prior exposure to a secondline injectable antibiotic was associated with a greater than threefold increase in hazard (adjusted HR, 3.65; 95% CI, 1.81-7.37), and each additional month in which a patient failed to take at least 80% of their prescribed drugs was associated with nearly an additional 20% hazard of developing XDR-TB (adjusted HR, 1.17; 95% CI, 1.01-1.35). Conclusions: Early and rapid diagnosis, timely initiation of appropriate therapy, and programmatic efforts to optimize treatment adherence during MDR-TB therapy are crucial to avoiding the generation of excess XDR-TB in MDR-TB treatment programs.

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“…The percentage utilisation of this service was 83.7% which emphasises the fact that this is a feasible operational modification (Table 4). 6 So delay in initiating treatment after diagnosis cannot be tolerated at any cost. The major concern from the peripheral centres over decentralisation was the possibility of overlooking any life threatening adverse events in terms of delay in picking up signs or due to lack of timely investigations.…”

Section: 3mentioning

confidence: 99%

Decentralising drug-resistant tuberculosis centre services by offering virtual consultancy- a Kozhikode model

et al. 2017

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Background: Programmatic management of Drug Resistant Tuberculosis (PMDT) recommends one week and one month hospitalisation for pre-treatment evaluation and initiation of second line medications to MDR and XDR patients respectively. Our experience in dealing with these patients prompted us to resort to decentralising DOTs plus services by offering a virtual consultancy to those cases which did not actually require hospitalisation. Aim of the study was to analyze the feasibility of decentralisation strategy adopted in DOTs plus patients to recommend it as a nationwide strategy.Methods: The study was an observational analysis conducted in the Department of Pulmonary Medicine in 373 MDR-TB patients enrolled under DOTs Plus programme for CAT-IV regime during the period between February 2009 and April 2013 and analysed the strategy of decentralization using the internet and expertise of Medical officers at the periphery.Results: The percentage utilisation of virtual consultancy was 83.7% which emphasises the fact that this is a feasible operational modification. Adverse events reported to this DRTB centre were 29.2% in the pre-proposed model period which is comparable to the model group (30.2%).Conclusions: This study shows that in a properly functioning DRTB centre decentralising the services to its peripheral centres is a feasible option utilising the virtual consultancy model as proposed.

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Treatment of extensively drug-resistant tuberculosis in Tomsk, Russia: a retrospective cohort study

Cited by 143 publications

References 24 publications

Treatment Outcomes of Patients with Multidrug-Resistant Tuberculosis (MDR- TB) Compared with Non-MDR-TB Infections in Peninsular Malaysia

Treatment Outcomes of Patients with Multidrug-Resistant Tuberculosis (MDR- TB) Compared with Non-MDR-TB Infections in Peninsular Malaysia

Development of Extensively Drug-resistant Tuberculosis during Multidrug-resistant Tuberculosis Treatment

Decentralising drug-resistant tuberculosis centre services by offering virtual consultancy- a Kozhikode model

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