Multidrug-Resistant Tuberculosis Treatment Failure Detection Depends on Monitoring Interval and Microbiological Method

Hdl Handle:
http://hdl.handle.net/10144/618725
Title:
Multidrug-Resistant Tuberculosis Treatment Failure Detection Depends on Monitoring Interval and Microbiological Method
Authors:
Mitnick, CD; White, RA; Lu, C; Rodriguez, CA; Bayona, J; Becerra, MC; Burgos, M; Centis, R; Cohen, T; Cox, H; D'Ambrosio, L; Danilovitz, M; Falzon, D; Gelmanova, IY; Gler, MT; Grinsdale, JA; Holtz, TH; Keshavjee, S; Leimane, V; Menzies, D; Migliori, GB; Milstein, MB; Mishustin, SP; Pagano, M; Quelapio, MI; Shean, K; Shin, SS; Tolman, AW; van der Walt, ML; Van Deun, A; Viiklepp, P
Journal:
European Respiratory Journal
Abstract:
Debate persists about monitoring method (culture or smear) and interval (monthly or less frequently) during treatment for multidrug-resistant tuberculosis (MDR-TB). We analysed existing data and estimated the effect of monitoring strategies on timing of failure detection.We identified studies reporting microbiological response to MDR-TB treatment and solicited individual patient data from authors. Frailty survival models were used to estimate pooled relative risk of failure detection in the last 12 months of treatment; hazard of failure using monthly culture was the reference.Data were obtained for 5410 patients across 12 observational studies. During the last 12 months of treatment, failure detection occurred in a median of 3 months by monthly culture; failure detection was delayed by 2, 7, and 9 months relying on bimonthly culture, monthly smear and bimonthly smear, respectively. Risk (95% CI) of failure detection delay resulting from monthly smear relative to culture is 0.38 (0.34-0.42) for all patients and 0.33 (0.25-0.42) for HIV-co-infected patients.Failure detection is delayed by reducing the sensitivity and frequency of the monitoring method. Monthly monitoring of sputum cultures from patients receiving MDR-TB treatment is recommended. Expanded laboratory capacity is needed for high-quality culture, and for smear microscopy and rapid molecular tests.
Publisher:
European Respiratory Society
Issue Date:
1-Sep-2016
URI:
http://hdl.handle.net/10144/618725
DOI:
10.1183/13993003.00462-2016
PubMed ID:
27587552
Submitted date:
2016-09-06
Language:
en
ISSN:
1399-3003
Appears in Collections:
TB

Full metadata record

DC FieldValue Language
dc.contributor.authorMitnick, CDen
dc.contributor.authorWhite, RAen
dc.contributor.authorLu, Cen
dc.contributor.authorRodriguez, CAen
dc.contributor.authorBayona, Jen
dc.contributor.authorBecerra, MCen
dc.contributor.authorBurgos, Men
dc.contributor.authorCentis, Ren
dc.contributor.authorCohen, Ten
dc.contributor.authorCox, Hen
dc.contributor.authorD'Ambrosio, Len
dc.contributor.authorDanilovitz, Men
dc.contributor.authorFalzon, Den
dc.contributor.authorGelmanova, IYen
dc.contributor.authorGler, MTen
dc.contributor.authorGrinsdale, JAen
dc.contributor.authorHoltz, THen
dc.contributor.authorKeshavjee, Sen
dc.contributor.authorLeimane, Ven
dc.contributor.authorMenzies, Den
dc.contributor.authorMigliori, GBen
dc.contributor.authorMilstein, MBen
dc.contributor.authorMishustin, SPen
dc.contributor.authorPagano, Men
dc.contributor.authorQuelapio, MIen
dc.contributor.authorShean, Ken
dc.contributor.authorShin, SSen
dc.contributor.authorTolman, AWen
dc.contributor.authorvan der Walt, MLen
dc.contributor.authorVan Deun, Aen
dc.contributor.authorViiklepp, Pen
dc.date.accessioned2016-12-09T21:02:26Z-
dc.date.available2016-12-09T21:02:26Z-
dc.date.issued2016-09-01-
dc.date.submitted2016-09-06-
dc.identifier.citationMultidrug-resistant tuberculosis treatment failure detection depends on monitoring interval and microbiological method. 2016: Eur. Respir. J.en
dc.identifier.issn1399-3003-
dc.identifier.pmid27587552-
dc.identifier.doi10.1183/13993003.00462-2016-
dc.identifier.urihttp://hdl.handle.net/10144/618725-
dc.description.abstractDebate persists about monitoring method (culture or smear) and interval (monthly or less frequently) during treatment for multidrug-resistant tuberculosis (MDR-TB). We analysed existing data and estimated the effect of monitoring strategies on timing of failure detection.We identified studies reporting microbiological response to MDR-TB treatment and solicited individual patient data from authors. Frailty survival models were used to estimate pooled relative risk of failure detection in the last 12 months of treatment; hazard of failure using monthly culture was the reference.Data were obtained for 5410 patients across 12 observational studies. During the last 12 months of treatment, failure detection occurred in a median of 3 months by monthly culture; failure detection was delayed by 2, 7, and 9 months relying on bimonthly culture, monthly smear and bimonthly smear, respectively. Risk (95% CI) of failure detection delay resulting from monthly smear relative to culture is 0.38 (0.34-0.42) for all patients and 0.33 (0.25-0.42) for HIV-co-infected patients.Failure detection is delayed by reducing the sensitivity and frequency of the monitoring method. Monthly monitoring of sputum cultures from patients receiving MDR-TB treatment is recommended. Expanded laboratory capacity is needed for high-quality culture, and for smear microscopy and rapid molecular tests.en
dc.languageENG-
dc.language.isoenen
dc.publisherEuropean Respiratory Societyen
dc.rightsArchived with thanks to the European Respiratory Societyen
dc.titleMultidrug-Resistant Tuberculosis Treatment Failure Detection Depends on Monitoring Interval and Microbiological Methoden
dc.identifier.journalEuropean Respiratory Journalen

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