Your browser doesn't support javascript.
loading
Evidence-based Definition for Extensively Drug-Resistant Tuberculosis.
Roelens, Maroussia; Battista Migliori, Giovanni; Rozanova, Liudmila; Estill, Janne; Campbell, Jonathon R; Cegielski, J Peter; Tiberi, Simon; Palmero, Domingo; Fox, Greg J; Guglielmetti, Lorenzo; Sotgiu, Giovanni; Brust, James C M; Bang, Didi; Lienhardt, Christian; Lange, Christoph; Menzies, Dick; Keiser, Olivia; Raviglione, Mario.
Afiliación
  • Roelens M; Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
  • Battista Migliori G; Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico, Tradate, Italy.
  • Rozanova L; Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
  • Estill J; Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
  • Campbell JR; Institute of Mathematical Statistics and Actuarial Science, University of Bern, Bern, Switzerland.
  • Cegielski JP; McGill International Tuberculosis Centre, McGill University, Montreal, Quebec, Canada.
  • Tiberi S; Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre, Montreal, Quebec, Canada.
  • Palmero D; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.
  • Fox GJ; Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.
  • Guglielmetti L; Division of Infection, Royal London Hospital, Barts Health National Health Service Trust, London, United Kingdom.
  • Sotgiu G; Hospital F. J. Muñiz, Buenos Aires, Argentina.
  • Brust JCM; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
  • Bang D; Équipe 13, Centre d'Immunologie et des Maladies Infectieuses, Sorbonne Université, Unité 1135, Institut National de la Santé et de la Recherche Médicale, Paris, France.
  • Lienhardt C; Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Hôpital Pitié-Salpêtrière, Groupe Hospitalier Universitaire Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Paris, France.
  • Lange C; Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy.
  • Menzies D; Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York.
  • Keiser O; Statens Serum Institut, Copenhagen, Denmark.
  • Raviglione M; Department of Clinical Microbiology, Copenhagen University Hospital Amager and Hvidovre, Copenhagen, Denmark.
Am J Respir Crit Care Med ; 204(6): 713-722, 2021 09 15.
Article en En | MEDLINE | ID: mdl-34107231
Rationale: Until 2020, extensively drug-resistant tuberculosis (XDR-TB) was defined as TB with resistance to rifampicin and isoniazid (multidrug-resistant TB [MDR-TB]), any fluoroquinolone (FQ), and any second-line injectable drug (SLID). In 2019, the World Health Organization issued new recommendations for treating patients with drug-resistant TB, substantially limiting the role of SLIDs in MDR-TB treatment and thus putting the definition of XDR-TB into question. Objectives: To propose an up-to-date definition for XDR-TB. Methods: We used a large data set to assess treatment outcomes for patients with MDR-TB exposed to any type of longer regimen. We included patients with bacteriologically confirmed MDR-TB and known FQ and SLID resistance results. We performed logistic regression to estimate the adjusted odds ratios (aORs) for an unfavorable treatment outcome (failure, relapse, death, loss to follow-up), and estimates were stratified by the resistance pattern (FQ and/or SLID) and group A drug use (moxifloxacin/levofloxacin, linezolid, and/or bedaquiline). Measurements and Main Results: We included 11,666 patients with MDR-TB; 4,653 (39.9%) had an unfavorable treatment outcome. Resistance to FQs increased the odds of an unfavorable treatment outcome (aOR, 1.91; 95% confidence interval [CI], 1.63-2.23). Administration of bedaquiline and/or linezolid improved treatment outcomes regardless of resistance to FQs and/or SLIDs. Among patients with XDR-TB, compared with persons receiving no group A drug, aORs for an unfavorable outcome were 0.37 (95% CI, 0.20-0.69) with linezolid only, 0.40 (95% CI, 0.21-0.77) with bedaquiline only, and 0.21 (95% CI, 0.12-0.38) with both. Conclusions: Our study supports a new definition of XDR-TB as MDR-TB and additional resistance to FQ plus bedaquiline and/or linezolid and helps assess the adequacy of this definition for surveillance and treatment choice.
Asunto(s)
Palabras clave
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Tuberculosis Extensivamente Resistente a Drogas / Antituberculosos Tipo de estudio: Etiology_studies / Guideline / Prognostic_studies / Risk_factors_studies / Systematic_reviews Límite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Am J Respir Crit Care Med Asunto de la revista: TERAPIA INTENSIVA Año: 2021 Tipo del documento: Article País de afiliación: Suiza Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Tuberculosis Extensivamente Resistente a Drogas / Antituberculosos Tipo de estudio: Etiology_studies / Guideline / Prognostic_studies / Risk_factors_studies / Systematic_reviews Límite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Am J Respir Crit Care Med Asunto de la revista: TERAPIA INTENSIVA Año: 2021 Tipo del documento: Article País de afiliación: Suiza Pais de publicación: Estados Unidos