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 SM ISO690:2012MAIER, 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 |
| EXPORT metadate: Google Scholar Crossref CERIF DataCite Dublin Core |
  Clinical Microbiology and Infection |
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| Volumul 29 / 2023 / ISSN 1198-743X /ISSNe 1469-0691 | ||||||
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| DOI:https://doi.org/10.1016/j.cmi.2023.02.013 | ||||||
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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. |
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| Cuvinte-cheie definitions, MDR-TB, Pre-XDR-TB, TBNET, XDR-TB |
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Dublin Core Export
<?xml version='1.0' encoding='utf-8'?> <oai_dc:dc xmlns:dc='http://purl.org/dc/elements/1.1/' xmlns:oai_dc='http://www.openarchives.org/OAI/2.0/oai_dc/' xmlns:xsi='http://www.w3.org/2001/XMLSchema-instance' xsi:schemaLocation='http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd'> <dc:creator>Maier, C.</dc:creator> <dc:creator>Chesov, D.I.</dc:creator> <dc:creator>Schaub, D.</dc:creator> <dc:creator>Kalsdorf, B.</dc:creator> <dc:creator>Andres, S.</dc:creator> <dc:creator>Friesen, I.</dc:creator> <dc:creator>Reimann , M.</dc:creator> <dc:creator>Lange, C.</dc:creator> <dc:date>2023-06-01</dc:date> <dc:description xml:lang='en'><p>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. </p></dc:description> <dc:identifier>10.1016/j.cmi.2023.02.013</dc:identifier> <dc:source>Clinical Microbiology and Infection () 751-757</dc:source> <dc:subject>definitions</dc:subject> <dc:subject>MDR-TB</dc:subject> <dc:subject>Pre-XDR-TB</dc:subject> <dc:subject>TBNET</dc:subject> <dc:subject>XDR-TB</dc:subject> <dc:title>Long-term treatment outcomes in patients with multidrug-resistant tuberculosis</dc:title> <dc:type>info:eu-repo/semantics/article</dc:type> </oai_dc:dc>
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