Clinical management of multidrug-resistant tuberculosis in 16 european countries
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GUNTHER, Gunar; ALEXANDRU, Sofia; BARBUŢĂ, Raisa; CIOBANU, Ana; CRUDU, Valeriu. Clinical management of multidrug-resistant tuberculosis in 16 european countries. In: American Journal of Respiratory and Critical Care Medicine. 2018, nr. 3(198), pp. 379-386. ISSN 1073-449X.
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American Journal of Respiratory and Critical Care Medicine
Numărul 3(198) / 2018 / ISSN 1073-449X

Clinical management of multidrug-resistant tuberculosis in 16 european countries

DOI: 10.1164/rccm.201710-2141OC
Pag. 379-386

Gunther Gunar12, Alexandru Sofia3, Barbuţă Raisa4, Ciobanu Ana3, Crudu Valeriu3
1 University of Namibia, School of Medicine, Windhoek,
2 German Centre for Infection Research (DZIF), Partner Site Hamburg-Luebeck-Borstel,
3 Institute of Phtysiopneumology „Chiril Draganiuc”,
4 Spitalul Clinic Municipal, Bălţi
Disponibil în IBN: 4 septembrie 2018


Rationale: Multidrug-resistant tuberculosis (MDR-TB) is a major burden to public health in Europe. Reported treatment success rates are around 50% or less, and cure rates are even lower. Objectives: To document the management and treatment outcome in patients with MDR-TB in Europe. Methods: We performed a prospective cohort study, analyzing management and treatment outcomes stratified by incidence of patients with MDR-TB in Europe. Treatment outcomes were compared by World Health Organization and alternative simplified definitions by the Tuberculosis Network European Trialsgroup (TBNET). Measurements and Main Results: A total of 380 patients with MDR-TB were recruited and followed up between 2010 and 2014 in 16 European countries. Patients in high-incidence countries compared with low-incidence countries were treated more frequently with standardized regimen (83.2% vs. 9.9%), had delayed treatment initiation (median, 111 vs. 28 d), developed more additional drug resistance (23% vs. 5.8%), and had increased mortality (9.4% vs. 1.9%). Only 20.1% of patients using pyrazinamide had proven susceptibility to the drug. Applying World Health Organization outcome definitions, frequency of cure (38.7% vs. 9.7%) was higher in high-incidence countries. Simplified outcome definitions that include 1 year of follow-up after the end of treatment showed similar frequency of relapse-free cure in low- (58.3%), intermediate- (55.8%), and high-incidence (57.1%) countries, but highest frequency of failure in high-incidence countries (24.1% vs. 14.6%). Conclusions: Conventional standard MDR-TB treatment regimens resulted in a higher frequency of failure compared with individualized treatments. Overall, cure from MDR-TB is substantially more frequent than previously anticipated, and poorly reflected by World Health Organization outcome definitions.

Extensively drug-resistant TB, MDR-TB, Outcome definitions, TBNET,