Time to Sputum Culture Conversion and Treatment Outcomes Among Patients with Isoniazid-Resistant Tuberculosis in Atlanta, Georgia.
| Autor: | Schechter, Marcos C., Bizune, Destani, Kagei, Michelle, Machaidze, Mamuka, Holland, David P., Oladele, Alawode, Wang, Yun F., Rebolledo, Paulina A., Ray, Susan M., Kempker, Russell R. |
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| Předmět: |
DRUG therapy for tuberculosis
FLUOROQUINOLONES CONFIDENCE intervals DRUG resistance in microorganisms ISONIAZID LONGITUDINAL method MICROBIAL sensitivity tests MULTIVARIATE analysis PROBABILITY theory SPUTUM STATISTICS TREATMENT effectiveness PROPORTIONAL hazards models RETROSPECTIVE studies DESCRIPTIVE statistics ODDS ratio THERAPEUTICS |
| Zdroj: | Clinical Infectious Diseases; Dec2017, Vol. 65 Issue 11, p1862-1871, 10p |
| Abstrakt: | Background. Although isoniazid-resistant tuberculosis is more common than multidrug-resistant tuberculosis, it has been much less studied. We examined the impact of isoniazid resistance and treatment regimen, including use of a fluoroquinolone, on clinical outcomes. Methods. A retrospective cohort study among patients with sputum culture-positive tuberculosis was performed. Early fluoroquinolone (FQ) use was defined as receiving ≥5 doses during the first month of treatment. The primary outcome was time to sputum culture conversion (tSCC). A multivariate proportional hazards model was used to determine the association of isoniazid resistance with tSCC. Results. Among 236 patients with pulmonary tuberculosis, 59 (25%) had isoniazid resistance. The median tSCC was similar for isoniazid-resistant and -susceptible cases (35 vs 29 days; P = .39), and isoniazid resistance was not associated with tSCC in multivariate analysis (adjusted hazard ratio = 0.83; 95% confidence interval [CI], .59-1.17). Early FQ use was higher in isoniazid-resistant than -susceptible cases (20% vs 10%; P = .05); however, it was not significantly associated with tSCC in univariate analysis (hazard ratio = 1.48; 95% CI, .95-2.28). Patients with isoniazid-resistant tuberculosis were treated with regimens containing rifampin, pyrazinamide, and ethambutol +/- a FQ for a median of 9.7 months. Overall, 191 (83%) patients were cured. There was no difference in initial treatment outcomes; however, all cases of acquired-drug resistance (n = 1) and recurrence (n = 3) occurred among patients with isoniazid-resistant tuberculosis. Conclusions. There was no significant association with isoniazid resistance and tSCC or initial treatment outcomes. Although patients with isoniazid-resistant tuberculosis had a high cure rate, the cases of recurrence and acquired drug resistance are concerning and highlight the need for longer-term follow-up studies. [ABSTRACT FROM AUTHOR] |
| Databáze: | Complementary Index |
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