High frequency of resistance, lack of clinical benefit, and poor outcomes in capreomycin treated South African patients with extensively drug-resistant tuberculosis
| Autor: | Neesha Rockwood, Barbara Lazaro Mastrapa, Keertan Dheda, Julian te Riele, Jonny Peter, Paul D. van Helden, Elizabeth M. Streicher, Robin M. Warren, F. A. Sirgel, Malika Davids, Elize Pietersen |
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| Přispěvatelé: | Department of Medicine, Faculty of Health Sciences |
| Jazyk: | angličtina |
| Rok vydání: | 2015 |
| Předmět: |
Adult
Male medicine.medical_specialty Tuberculosis Capreomycin Extensively Drug-Resistant Tuberculosis Antitubercular Agents lcsh:Medicine HIV Infections Microbial Sensitivity Tests Drug resistance Mycobacterium tuberculosis South Africa Pharmacotherapy Drug Resistance Multiple Bacterial Internal medicine medicine Tuberculosis diagnosis and management Humans Treatment Failure Multi-drug-resistant tuberculosis lcsh:Science Retrospective Studies Multidisciplinary biology Coinfection business.industry lcsh:R Sputum Extensively drug-resistant tuberculosis HIV diagnosis and management medicine.disease biology.organism_classification humanities Treatment Outcome Drug screening Mutation Immunology Female lcsh:Q Drug therapy business Research Article medicine.drug |
| Zdroj: | PLoS ONE, Vol 10, Iss 4, p e0123655 (2015) PLoS ONE PLoS One |
| ISSN: | 1932-6203 |
| Popis: | BACKGROUND: There are limited data about the epidemiology and treatment-related outcomes associated with capreomycin resistance in patients with XDR-TB. Capreomycin achieves high serum concentrations relative to MIC but whether capreomycin has therapeutic benefit despite microbiological resistance remains unclear. METHODS: We reviewed the susceptibility profiles and outcomes associated with capreomycin usage in patients diagnosed with XDR-TB between August 2002 and October 2012 in two provinces of South Africa. Patients whose isolates were genotypically tested for capreomycin resistance were included in the analysis. RESULTS: Of 178 XDR-TB patients 41% were HIV-infected. 87% (154/178) isolates contained a capreomycin resistance-conferring mutation [80% (143/178) rrs A1401G and 6% (11/178) were heteroresistant (containing both the rrs A1401G mutation and wild-type sequences)]. Previous MDR-TB treatment, prior usage of kanamycin, or strain type was not associated with capreomycin resistance. 92% (163/178) of XDR-TB patients were empirically treated with capreomycin. Capreomycin resistance decreased the odds of sputum culture conversion. In capreomycin sensitive and resistant persons combined weight at diagnosis was the only independent predictor for survival (p= |
| Databáze: | OpenAIRE |
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