Long-term treatment outcomes in patients with multidrug-resistant tuberculosis

Maier Christina; Chesov Dumitru; Schaub Dagmar; Kalsdorf Barbara; Andres Sonke; Friesen Inna; Reimann  Maja; Lange Christoph G.

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MAIER, Christina, CHESOV, Dumitru, SCHAUB, Dagmar, KALSDORF, Barbara, ANDRES, Sonke, FRIESEN, Inna, REIMANN , Maja, LANGE, Christoph G.. Long-term treatment outcomes in patients with multidrug-resistant tuberculosis. In: Clinical Microbiology and Infection, 2023, vol. 29, pp. 751-757. ISSN 1198-743X. DOI: https://doi.org/10.1016/j.cmi.2023.02.013

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Clinical Microbiology and Infection

Volumul 29 / 2023 / ISSN 1198-743X /ISSNe 1469-0691

Long-term treatment outcomes in patients with multidrug-resistant tuberculosis

DOI:https://doi.org/10.1016/j.cmi.2023.02.013

Pag. 751-757

Maier Christina¹²³, Chesov Dumitru¹²⁴, Schaub Dagmar¹²³, Kalsdorf Barbara¹²³, Andres Sonke⁵, Friesen Inna⁵, Reimann Maja⁵²³, Lange Christoph G.⁵²³⁶

¹ Research Center Boreal,
² German Center for Infection Research, Tuberculosis Unit, Borstel,
³ University of Lübeck,
⁴ ”Nicolae Testemițanu” State University of Medicine and Pharmacy,
⁵ Research Center Borstel,
⁶ Baylor College of Medicine

Disponibil în IBN: 6 noiembrie 2023

Rezumat

Objectives: To describe long-term treatment outcomes in patients with multi-drug-resistant/rifampicin-resistant tuberculosis (MDR/RR-TB) and validate established outcome definitions for MDR/RR-TB treatment. Methods: Among patients with MDR/RR-TB admitted to a German MDR/RR-TB referral centre from 1 September 2002 to 29 February 2020, we compared long-term treatment outcomes derived from individual patient follow-up with treatment outcomes defined by WHO-2013, WHO-2021 and the Tuberculosis Network European Trials Group-2016. Results: In a total of 163 patients (mean age, 35 years; standard deviation, 13 years; 14/163 [8.6%] living with HIV; 109/163 [66.9%] men, 149/163 [91.4%] migrating to Germany within 5 years), the treatment of culture-confirmed MDR/RR-TB was initiated. Additional drug resistance to a fluoroquinolone or a second-line injectable agent was present in 15 of the 163 (9.2%) Mycobacterium tuberculosis strains; resistance against both the drug classes was present in 29 of the 163 (17.8%) strains. The median duration of MDR/RR-TB treatment was 20 months (interquartile range, 19.3–21.6 months), with a medium of five active drugs included. The median follow-up time was 4 years (47.7 months; interquartile range, 21.7–65.8 months). Among the 163 patients, cure was achieved in 25 (15.3%), 82 (50.3%) and 95 (58.3%) patients according to the outcome definitions of WHO-2013, WHO-2021, and the Tuberculosis Network European Trials Group-2016, respectively. The lost to follow-up rate was 17 of 163 (10.4%). Death was more likely in patients living with HIV (hazard ratio, 4.28; 95% confidence interval, 1.26–12.86) and older patients (hazard ratio, 1.08; 95% confidence interval, 1.05–1.12; increment of 1 year). Overall, 101/163 (62.0%) patients experienced long-term, relapse-free cure; of those, 101/122 (82.8%) patients with a known status (not lost to-follow-up or transferred out) at follow-up. Conclusion: Under optimal management conditions leveraging individualized treatment regimens, long-term, relapse-free cure from MDR/RR-TB is substantially higher than cure rates defined by current treatment outcome definitions.

Cuvinte-cheie
definitions, MDR-TB, Pre-XDR-TB, TBNET, XDR-TB

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