Drug susceptibility patterns of Mycobacterium tuberculosis from adults with multidrug-resistant tuberculosis and implications for a household contact preventive therapy trial.

Autor: Demers AM; Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa., Kim S; Department of Biostatistics, Frontier Science Foundation, Brookline, MA, USA., McCallum S; Harvard T.H. Chan School of Public Health, Boston, MA, USA., Eisenach K; TB or NOT TB Consulting, LLC, Little Rock, AR, USA., Hughes M; Harvard T.H. Chan School of Public Health, Boston, MA, USA., Naini L; Social & Scientific Systems, Inc., Silver Spring, MD, USA., Mendoza-Ticona A; Barranco Clinical Research Site, Lima, Peru., Pradhan N; Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India., Narunsky K; UCTLI, Cape Town, South Africa., Poongulali S; Chennai Antiviral Research and Treatment (CART) Clinical Research Site, Infectious Diseases Medical Center, Voluntary Health Services, Chennai, India., Badal-Faesen S; University of the Witwatersrand Helen Joseph (WITS HJH) CRS, Johannesburg, South Africa., Upton C; TASK Applied Science, Cape Town, South Africa., Smith E; DAIDS, NIH, Bethesda, MD, USA., Shah NS; Centers for Disease Control and Prevention, Atlanta, GA, USA., Churchyard G; Aurum Institute, Parktown, South Africa.; School of Public Health, University of Witwatersrand, Johannesburg, South Africa., Gupta A; Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India.; Department of Medicine, Johns Hopkins University, Baltimore, MD, USA., Hesseling A; Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa., Swindells S; Department of Internal Medicine, Section of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, 68198-8106, USA. sswindells@unmc.edu.
Jazyk: angličtina
Zdroj: BMC infectious diseases [BMC Infect Dis] 2021 Feb 24; Vol. 21 (1), pp. 205. Date of Electronic Publication: 2021 Feb 24.
DOI: 10.1186/s12879-021-05884-4
Abstrakt: Background: Drug susceptibility testing (DST) patterns of Mycobacterium tuberculosis (MTB) from patients with rifampicin-resistant tuberculosis (RR-TB) or multidrug-resistant TB (MDR-TB; or resistant to rifampicin and isoniazid (INH)), are important to guide preventive therapy for their household contacts (HHCs).
Methods: As part of a feasibility study done in preparation for an MDR-TB preventive therapy trial in HHCs, smear, Xpert MTB/RIF, Hain MTBDRplus, culture and DST results of index MDR-TB patients were obtained from routine TB programs. A sputum sample was collected at study entry and evaluated by the same tests. Not all tests were performed on all specimens due to variations in test availability.
Results: Three hundred eight adults with reported RR/MDR-TB were enrolled from 16 participating sites in 8 countries. Their median age was 36 years, and 36% were HIV-infected. Routine testing on all 308 were confirmed as having RR-TB, but only 75% were documented as having MDR-TB. The majority of those not classified as having MDR-TB were because only rifampicin resistance was tested. At study entry (median 59 days after MDR-TB treatment initiation), 280 participants (91%) were able to produce sputum for the study, of whom 147 (53%) still had detectable MTB. All but 2 of these 147 had rifampicin DST done, with resistance detected in 89%. Almost half (47%) of the 147 specimens had INH DST done, with 83% resistance. Therefore, 20% of the 280 study specimens had MDR-TB confirmed. Overall, DST for second-line drugs were available in only 35% of the 308 routine specimens and 15% of 280 study specimens.
Conclusions: RR-TB was detected in all routine specimens but only 75% had documented MDR-TB, illustrating the need for expanded DST beyond Xpert MTB/RIF to target preventive therapy for HHC.
Databáze: MEDLINE
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