Bacterial risk factors for treatment failure and relapse among patients with isoniazid resistant tuberculosis.

Autor: Thai PVK; Pham Ngoc Thach Hospital, 120 Hung Vuong, Ho Chi Minh City, Vietnam., Ha DTM; Pham Ngoc Thach Hospital, 120 Hung Vuong, Ho Chi Minh City, Vietnam., Hanh NT; Oxford University Clinical Research Unit, 763 Vo Van Kiet, Ho Chi Minh City, Vietnam., Day J; Oxford University Clinical Research Unit, 763 Vo Van Kiet, Ho Chi Minh City, Vietnam., Dunstan S; Oxford University Clinical Research Unit, 763 Vo Van Kiet, Ho Chi Minh City, Vietnam.; University of Melbourne, Melbourne, Australia., Nhu NTQ; Oxford University Clinical Research Unit, 763 Vo Van Kiet, Ho Chi Minh City, Vietnam., Kiet VS; Oxford University Clinical Research Unit, 763 Vo Van Kiet, Ho Chi Minh City, Vietnam., Lan NH; Pham Ngoc Thach Hospital, 120 Hung Vuong, Ho Chi Minh City, Vietnam., Dung NH; Pham Ngoc Thach Hospital, 120 Hung Vuong, Ho Chi Minh City, Vietnam., Lan NTN; Pham Ngoc Thach Hospital, 120 Hung Vuong, Ho Chi Minh City, Vietnam., Thuong NT; Oxford University Clinical Research Unit, 763 Vo Van Kiet, Ho Chi Minh City, Vietnam., Lan NN; Pham Ngoc Thach Hospital, 120 Hung Vuong, Ho Chi Minh City, Vietnam., Liễu PTT; Pham Ngoc Thach Hospital, 120 Hung Vuong, Ho Chi Minh City, Vietnam., Hồng NT; Pham Ngoc Thach Hospital, 120 Hung Vuong, Ho Chi Minh City, Vietnam., Điệp ĐC; Pham Ngoc Thach Hospital, 120 Hung Vuong, Ho Chi Minh City, Vietnam., Thanh NTK; Pham Ngoc Thach Hospital, 120 Hung Vuong, Ho Chi Minh City, Vietnam., Hội NV; Pham Ngoc Thach Hospital, 120 Hung Vuong, Ho Chi Minh City, Vietnam., Nghĩa NV; Pham Ngoc Thach Hospital, 120 Hung Vuong, Ho Chi Minh City, Vietnam., Đại TN; Pham Ngoc Thach Hospital, 120 Hung Vuong, Ho Chi Minh City, Vietnam., Minh HQ; Pham Ngoc Thach Hospital, 120 Hung Vuong, Ho Chi Minh City, Vietnam., Thơm NV; Pham Ngoc Thach Hospital, 120 Hung Vuong, Ho Chi Minh City, Vietnam., Farrar J; Oxford University Clinical Research Unit, 763 Vo Van Kiet, Ho Chi Minh City, Vietnam., Caws M; Oxford University Clinical Research Unit, 763 Vo Van Kiet, Ho Chi Minh City, Vietnam. mcaws@hotmail.com.; Liverpool School of Tropical Medicine, Pembroke Place, L3 5QA, Liverpool, UK. mcaws@hotmail.com.; Birat-Nepal Medical Trust, Kathmandu, Lazimpat, Nepal. mcaws@hotmail.com.
Jazyk: angličtina
Zdroj: BMC infectious diseases [BMC Infect Dis] 2018 Mar 06; Vol. 18 (1), pp. 112. Date of Electronic Publication: 2018 Mar 06.
DOI: 10.1186/s12879-018-3033-9
Abstrakt: Background: Drug resistant tuberculosis (TB) is increasing in prevalence worldwide. Treatment failure and relapse is known to be high for patients with isoniazid resistant TB treated with standard first line regimens. However, risk factors for unfavourable outcomes and the optimal treatment regimen for isoniazid resistant TB are unknown. This cohort study was conducted when Vietnam used the eight month first line treatment regimen and examined risk factors for failure/relapse among patients with isoniazid resistant TB.
Methods: Between December 2008 and June 2011 2090 consecutive HIV-negative adults (≥18 years of age) with new smear positive pulmonary TB presenting at participating district TB units in Ho Chi Minh City were recruited. Participants with isoniazid resistant TB identified by Microscopic Observation Drug Susceptibility (MODS) had extended follow-up for 2 years with mycobacterial culture to test for relapse. MGIT drug susceptibility testing confirmed 239 participants with isoniazid resistant, rifampicin susceptible TB. Bacterial and demographic factors were analysed for association with treatment failure and relapse.
Results: Using only routine programmatic sputum smear microscopy for assessment, (months 2, 5 and 8) 30/239 (12.6%) had an unfavourable outcome by WHO criteria. Thirty-nine patients were additionally detected with unfavourable outcomes during 2 year follow up, giving a total of 69/239 (28.9%) of isoniazid (INH) resistant cases with unfavourable outcome by 2 years of follow-up. Beijing lineage was the only factor significantly associated with unfavourable outcome among INH-resistant TB cases during 2 years of follow-up. (adjusted OR = 3.16 [1.54-6.47], P = 0.002).
Conclusion: One third of isoniazid resistant TB cases suffered failure/relapse within 2 years under the old eight month regimen. Over half of these cases were not identified by standard WHO recommended treatment monitoring. Intensified research on early identification and optimal regimens for isoniazid resistant TB is needed. Infection with Beijing genotype of TB is a significant risk factor for bacterial persistence on treatment resulting in failure/relapse within 2 years. The underlying mechanism of increased tolerance for standard drug regimens in Beijing genotype strains remains unknown.
Databáze: MEDLINE
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