Multidrug-Resistant Tuberculosis Treatment Failure Detection Depends on Monitoring Interval and Microbiological Method
Authors
Mitnick, CDWhite, 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
Issue Date
2016-09-01Submitted date
2016-09-06
Metadata
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European Respiratory JournalAbstract
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 SocietyPubMed ID
27587552Language
enISSN
1399-3003ae974a485f413a2113503eed53cd6c53
10.1183/13993003.00462-2016
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