Multidrug-resistant tuberculosis treatment failure detection depends on monitoring interval and microbiological method.

Autor:	Mitnick CD; Dept of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA Partners in Health, Boston, MA, USA carole_mitnick@hms.harvard.edu., White RA; Dept of Infectious Disease Epidemiology, Norwegian Institute of Public Health, Oslo, Norway Dept of Health Statistics, Norwegian Institute of Public Health, Oslo, Norway., Lu C; Dept of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA Brigham and Women's Hospital, Division of Global Health Equity, Boston, MA, USA., Rodriguez CA; Dept of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA., Bayona J; Socios en Salud Sucursal, Lima, Peru., Becerra MC; Dept of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA Partners in Health, Boston, MA, USA Brigham and Women's Hospital, Division of Global Health Equity, Boston, MA, USA., Burgos M; Dept of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA., Centis R; WHO Collaborating Centre for TB and Lung Diseases, Fondazione S. Maugeri, Care and Research Institute, Tradate, Italy., Cohen T; Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA., Cox H; Médecins Sans Frontières, Cape Town, South Africa., D'Ambrosio L; WHO Collaborating Centre for TB and Lung Diseases, Fondazione S. Maugeri, Care and Research Institute, Tradate, Italy Public Health Consulting Group, Lugano, Switzerland., Danilovitz M; Tartu University Hospital, Lung Clinic, Tartu, Estonia., Falzon D; Global TB Programme, World Health Organization, Geneva, Switzerland., Gelmanova IY; Partners in Health Russia, Moscow, Russia., Gler MT; Makati Medical Center, Manila, Philippines., Grinsdale JA; Tuberculosis Control, San Francisco Department of Public Health, San Francisco, CA, USA., Holtz TH; US Centers for Disease Control and Prevention, Atlanta, GA, USA., Keshavjee S; Dept of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA Partners in Health, Boston, MA, USA Brigham and Women's Hospital, Division of Global Health Equity, Boston, MA, USA., Leimane V; State Agency for Tuberculosis and Lung Diseases (TPSVA), Riga, Latvia., Menzies D; Montreal Chest Institute, McGill University, Montreal, QC, Canada., Migliori GB; WHO Collaborating Centre for TB and Lung Diseases, Fondazione S. Maugeri, Care and Research Institute, Tradate, Italy., Milstein MB; Dept of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA., Mishustin SP; Tomsk TB and Pulmonary Medical Center, Tomsk Oblast, Russia., Pagano M; Dept of Biostatistics, Harvard School of Public Health, Boston, MA, USA., Quelapio MI; Tropical Disease Foundation, Philippine Institute of Tuberculosis, Makati City, Philippines., Shean K; Lung Infection and Immunity Unit, Division of Pulmonology and UCT Lung Institute, Dept of Medicine, University of Cape Town, Cape Town, South Africa., Shin SS; Dept of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA Partners in Health, Boston, MA, USA Brigham and Women's Hospital, Division of Global Health Equity, Boston, MA, USA Socios en Salud Sucursal, Lima, Peru., Tolman AW; Dept of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA., van der Walt ML; South African Medical Research Council, Tuberculosis Research Platform, Pretoria, South Africa., Van Deun A; Institute of Tropical Medicine, Antwerp, Belgium., Viiklepp P; National Institute for Heath Development, Tallinn, Estonia.
Jazyk:	angličtina
Zdroj:	The European respiratory journal [Eur Respir J] 2016 Oct; Vol. 48 (4), pp. 1160-1170. Date of Electronic Publication: 2016 Sep 01.
DOI:	10.1183/13993003.00462-2016
Abstrakt:	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. Competing Interests: can be found alongside this article at erj.ersjournals.com (The content of this work is copyright the authors or their employers. Design and branding are copyright ©ERS 2016.)
Databáze:	MEDLINE
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