Surgical interventions for drug-resistant tuberculosis: a systematic review and meta-analysis [Review article]
| Autor: | Vidya Venkataramanan, A C Hill, Michael Marrone, Michael Goodman, J A Jereb, Sundari Mase |
|---|---|
| Rok vydání: | 2013 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty Chemotherapy Tuberculosis business.industry medicine.medical_treatment Drug resistant tuberculosis Psychological intervention MEDLINE Increased drug resistance medicine.disease Infectious Diseases Meta-analysis medicine Intensive care medicine business Surgical interventions |
| Zdroj: | The International Journal of Tuberculosis and Lung Disease. 17:6-16 |
| ISSN: | 1815-7920 1027-3719 |
| DOI: | 10.5588/ijtld.12.0198 |
| Popis: | Background With the emergence of multidrug-resistant (MDR-) and extensively drug-resistant tuberculosis (XDR-TB), surgery, which had been replaced by short-course chemotherapy, is again being considered a viable treatment option. Objective To assess the literature on the effectiveness of surgical interventions in the treatment of drug-resistant TB. Methods Medline, EMBASE, and PubMed were searched from 1975 to April 2012 in addition to hand searching reference lists, and the International Journal of Tuberculosis and Lung Disease. Potentially relevant studies were assessed according to pre-defined eligibility criteria: MDR- and XDR-TB patients undergoing surgical and non-surgical treatment. Treatment outcomes were extracted according to internationally accepted definitions and included in meta-analyses using random effects models. Results Summary meta-analysis of 24 comparison studies revealed a significant association between surgery and successful treatment compared to non-surgical interventions (OR 2.24, 95%CI 1.68-2.97). A meta-analysis from 23 single-arm studies demonstrated that respectively 92% (95%CI 88.1-95) and 87% (95%CI 83-91) of surgical patients achieved successful short- and long-term outcomes. Subgroup analyses showed that favorable surgical outcomes were associated with increased drug resistance in studies reporting surgical and non-surgical treatment outcomes. Conclusions While the results suggest that surgical intervention is associated with successful treatment outcomes in patients with drug-resistant TB, there is insufficient evidence to recommend surgery plus chemotherapy over chemotherapy alone, to evaluate the potential harm from surgery and to determine the optimal conditions for surgery. Controlled studies are needed to better assess the effectiveness of surgery and to investigate other contextual issues. |
| Databáze: | OpenAIRE |
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