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dc.contributor.authorMitnick, CD
dc.contributor.authorWhite, RA
dc.contributor.authorLu, C
dc.contributor.authorRodriguez, CA
dc.contributor.authorBayona, J
dc.contributor.authorBecerra, MC
dc.contributor.authorBurgos, M
dc.contributor.authorCentis, R
dc.contributor.authorCohen, T
dc.contributor.authorCox, H
dc.contributor.authorD'Ambrosio, L
dc.contributor.authorDanilovitz, M
dc.contributor.authorFalzon, D
dc.contributor.authorGelmanova, IY
dc.contributor.authorGler, MT
dc.contributor.authorGrinsdale, JA
dc.contributor.authorHoltz, TH
dc.contributor.authorKeshavjee, S
dc.contributor.authorLeimane, V
dc.contributor.authorMenzies, D
dc.contributor.authorMigliori, GB
dc.contributor.authorMilstein, MB
dc.contributor.authorMishustin, SP
dc.contributor.authorPagano, M
dc.contributor.authorQuelapio, MI
dc.contributor.authorShean, K
dc.contributor.authorShin, SS
dc.contributor.authorTolman, AW
dc.contributor.authorvan der Walt, ML
dc.contributor.authorVan Deun, A
dc.contributor.authorViiklepp, P
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.
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
dc.internal.reviewer-noteEurop Resp Jen
refterms.dateFOA2019-03-04T12:59:57Z
html.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.
dc.relation.isnodouble556156*
dc.relation.isnodouble560304*
dc.relation.isnodouble447462*
dc.relation.isnodouble559562*


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