Outcomes from patients with presumed drug resistant tuberculosis in five reference centers in Brazil

BMC Infectious Diseases

Research Article

E. Mesquita¹  A. N. Gambirasio²  M. P. Dalcolmo³  J. Ueleres Braga³  P. I. Fujiwara⁴  A. Detjen⁴  I. Langley⁵  S. B. Squire⁵  P. P. J. Phillips⁶  T. Brígido⁷  C. F. Dias⁸  D. M. P. Ramalho⁹  A. L. Kritski⁹  M. M. Oliveira⁹  P. F. C. Miranda⁹  M. K. Andrade^1,10 

[1] Ary Parreiras Institute – State Secretary of Health, Rio de Janeiro, Brazil;Clemente Ferreira Institute - State Secretary of Health, Sao Paulo, Brazil;Helio Fraga Reference Center – ENSP –Fiocruz, Rio de Janeiro, Brazil;International Union Against Tuberculosis and Lung Disease, Paris, France;Liverpool School of Tropical Medicine, Liverpool, UK;MRC Clinical Trials Unit, London, UK;Messejana Hospital –State Secretary of Health, Fortaleza, Ceará, Brazil;Sanatório Partenon Hospital - State Secretary of Health, Porto Alegre, Rio Grande do Sul, Brazil;Tuberculosis Academic Program, Medical School and Hospital Complex HUCFF-IDT, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil;Tuberculosis Academic Program, Medical School and Hospital Complex HUCFF-IDT, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil;Helio Fraga Reference Center – ENSP –Fiocruz, Rio de Janeiro, Brazil;

关键词: Multi-drug resistant tuberculosis;    Diagnosis;    Treatment outcome;   

DOI  :  10.1186/s12879-017-2669-1

 received in 2016-08-21, accepted in 2017-08-07,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundThe implementation of rapid drug susceptibility testing (DST) is a current global priority for TB control. However, data are scarce on patient-relevant outcomes for presumptive diagnosis of drug-resistant tuberculosis (pDR-TB) evaluated under field conditions in high burden countries.MethodsObservational study of pDR-TB patients referred by primary and secondary health units. TB reference centers addressing DR-TB in five cities in Brazil. Patients age 18 years and older were eligible if pDR-TB, culture positive results for Mycobacterium tuberculosis and, if no prior DST results from another laboratory were used by a physician to start anti-TB treatment. The outcome measures were median time from triage to initiating appropriate anti-TB treatment, empirical treatment and, the treatment outcomes.ResultsBetween February,16th, 2011 and February, 15th, 2012, among 175 pDR TB cases, 110 (63.0%) confirmed TB cases with DST results were enrolled. Among study participants, 72 (65.5%) were male and 62 (56.4%) aged 26 to 45 years. At triage, empirical treatment was given to 106 (96.0%) subjects. Among those, 85 were treated with first line drugs and 21 with second line. Median time for DST results was 69.5 [interquartile - IQR: 35.7–111.0] days and, for initiating appropriate anti-TB treatment, the median time was 1.0 (IQR: 0–41.2) days. Among 95 patients that were followed-up during the first 6 month period, 24 (25.3%; IC: 17.5%–34.9%) changed or initiated the treatment after DST results: 16/29 MDRTB, 5/21 DR-TB and 3/45 DS-TB cases. Comparing the treatment outcome to DS-TB cases, MDRTB had higher proportions changing or initiating treatment after DST results (p = 0.01) and favorable outcomes (p = 0.07).ConclusionsThis study shows a high rate of empirical treatment and long delay for DST results. Strategies to speed up the detection and early treatment of drug resistant TB should be prioritized.

【 授权许可】

CC BY   
© The Author(s). 2017