Treatment of tuberculosis in a region with high drug resistance: outcomes, drug resistance amplification and re-infection.

<h4>Introduction</h4>Emerging antituberculosis drug resistance is a serious threat for tuberculosis (TB) control, especially in Eastern European countries.<h4>Methods</h4>We combined drug susceptibility results and molecular strain typing data with treatment outcome reports t...

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Autores principales:	Maryline Bonnet, Manuela Pardini, Francesca Meacci, Germano Orrù, Hasan Yesilkaya, Thierry Jarosz, Peter W Andrew, Mike Barer, Francesco Checchi, Heinz Rinder, Graziella Orefici, Sabine Rüsch-Gerdes, Lanfranco Fattorini, Marco Rinaldo Oggioni, Juliet Melzer, Stefan Niemann, Francis Varaine
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2011
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/7d2ec4110db64177ae6cb52ec9fa55f1
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spelling	oai:doaj.org-article:7d2ec4110db64177ae6cb52ec9fa55f12021-11-18T06:47:29ZTreatment of tuberculosis in a region with high drug resistance: outcomes, drug resistance amplification and re-infection.1932-620310.1371/journal.pone.0023081https://doaj.org/article/7d2ec4110db64177ae6cb52ec9fa55f12011-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/21886778/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Introduction</h4>Emerging antituberculosis drug resistance is a serious threat for tuberculosis (TB) control, especially in Eastern European countries.<h4>Methods</h4>We combined drug susceptibility results and molecular strain typing data with treatment outcome reports to assess the influence of drug resistance on TB treatment outcomes in a prospective cohort of patients from Abkhazia (Georgia). Patients received individualized treatment regimens based on drug susceptibility testing (DST) results. Definitions for antituberculosis drug resistance and treatment outcomes were in line with current WHO recommendations. First and second line DST, and molecular typing were performed in a supranational laboratory for Mycobacterium tuberculosis (MTB) strains from consecutive sputum smear-positive TB patients at baseline and during treatment.<h4>Results</h4>At baseline, MTB strains were fully drug-susceptible in 189/326 (58.0%) of patients. Resistance to at least H or R (PDR-TB) and multidrug-resistance (MDR-TB) were found in 69/326 (21.2%) and 68/326 (20.9%) of strains, respectively. Three MDR-TB strains were also extensively resistant (XDR-TB). During treatment, 3/189 (1.6%) fully susceptible patients at baseline were re-infected with a MDR-TB strain and 2/58 (3.4%) PDR-TB patients became MDR-TB due to resistance amplification. 5/47 (10.6%) MDR- patients became XDR-TB during treatment. Treatment success was observed in 161/189 (85.2%), 54/69 (78.3%) and 22/68 (32.3%) of patients with fully drug susceptible, PDR- and MDR-TB, respectively. Development of ofloxacin resistance was significantly associated with a negative treatment outcome.<h4>Conclusion</h4>In Abkhazia, a region with high prevalence of drug resistant TB, the use of individualized MDR-TB treatment regimens resulted in poor treatment outcomes and XDR-TB amplification. Nosocomial transmission of MDR-TB emphasizes the importance of infection control in hospitals.Maryline BonnetManuela PardiniFrancesca MeacciGermano OrrùHasan YesilkayaThierry JaroszPeter W AndrewMike BarerFrancesco ChecchiHeinz RinderGraziella OreficiSabine Rüsch-GerdesLanfranco FattoriniMarco Rinaldo OggioniJuliet MelzerStefan NiemannFrancis VarainePublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 6, Iss 8, p e23081 (2011)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Maryline Bonnet Manuela Pardini Francesca Meacci Germano Orrù Hasan Yesilkaya Thierry Jarosz Peter W Andrew Mike Barer Francesco Checchi Heinz Rinder Graziella Orefici Sabine Rüsch-Gerdes Lanfranco Fattorini Marco Rinaldo Oggioni Juliet Melzer Stefan Niemann Francis Varaine Treatment of tuberculosis in a region with high drug resistance: outcomes, drug resistance amplification and re-infection.
description	<h4>Introduction</h4>Emerging antituberculosis drug resistance is a serious threat for tuberculosis (TB) control, especially in Eastern European countries.<h4>Methods</h4>We combined drug susceptibility results and molecular strain typing data with treatment outcome reports to assess the influence of drug resistance on TB treatment outcomes in a prospective cohort of patients from Abkhazia (Georgia). Patients received individualized treatment regimens based on drug susceptibility testing (DST) results. Definitions for antituberculosis drug resistance and treatment outcomes were in line with current WHO recommendations. First and second line DST, and molecular typing were performed in a supranational laboratory for Mycobacterium tuberculosis (MTB) strains from consecutive sputum smear-positive TB patients at baseline and during treatment.<h4>Results</h4>At baseline, MTB strains were fully drug-susceptible in 189/326 (58.0%) of patients. Resistance to at least H or R (PDR-TB) and multidrug-resistance (MDR-TB) were found in 69/326 (21.2%) and 68/326 (20.9%) of strains, respectively. Three MDR-TB strains were also extensively resistant (XDR-TB). During treatment, 3/189 (1.6%) fully susceptible patients at baseline were re-infected with a MDR-TB strain and 2/58 (3.4%) PDR-TB patients became MDR-TB due to resistance amplification. 5/47 (10.6%) MDR- patients became XDR-TB during treatment. Treatment success was observed in 161/189 (85.2%), 54/69 (78.3%) and 22/68 (32.3%) of patients with fully drug susceptible, PDR- and MDR-TB, respectively. Development of ofloxacin resistance was significantly associated with a negative treatment outcome.<h4>Conclusion</h4>In Abkhazia, a region with high prevalence of drug resistant TB, the use of individualized MDR-TB treatment regimens resulted in poor treatment outcomes and XDR-TB amplification. Nosocomial transmission of MDR-TB emphasizes the importance of infection control in hospitals.
format	article
author	Maryline Bonnet Manuela Pardini Francesca Meacci Germano Orrù Hasan Yesilkaya Thierry Jarosz Peter W Andrew Mike Barer Francesco Checchi Heinz Rinder Graziella Orefici Sabine Rüsch-Gerdes Lanfranco Fattorini Marco Rinaldo Oggioni Juliet Melzer Stefan Niemann Francis Varaine
author_facet	Maryline Bonnet Manuela Pardini Francesca Meacci Germano Orrù Hasan Yesilkaya Thierry Jarosz Peter W Andrew Mike Barer Francesco Checchi Heinz Rinder Graziella Orefici Sabine Rüsch-Gerdes Lanfranco Fattorini Marco Rinaldo Oggioni Juliet Melzer Stefan Niemann Francis Varaine
author_sort	Maryline Bonnet
title	Treatment of tuberculosis in a region with high drug resistance: outcomes, drug resistance amplification and re-infection.
title_short	Treatment of tuberculosis in a region with high drug resistance: outcomes, drug resistance amplification and re-infection.
title_full	Treatment of tuberculosis in a region with high drug resistance: outcomes, drug resistance amplification and re-infection.
title_fullStr	Treatment of tuberculosis in a region with high drug resistance: outcomes, drug resistance amplification and re-infection.
title_full_unstemmed	Treatment of tuberculosis in a region with high drug resistance: outcomes, drug resistance amplification and re-infection.
title_sort	treatment of tuberculosis in a region with high drug resistance: outcomes, drug resistance amplification and re-infection.
publisher	Public Library of Science (PLoS)
publishDate	2011
url	https://doaj.org/article/7d2ec4110db64177ae6cb52ec9fa55f1
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Treatment of tuberculosis in a region with high drug resistance: outcomes, drug resistance amplification and re-infection.

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