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

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Ramalho, D.M.P, Miranda, P.F.C., Andrade, M.K., Brigido, T., Dalcolmo, M.P., Mesquita, E., Dias, C.F., Gambirasio, A.N., Ueleres Braga, J., Detjen, A., Phillips, P.P.J., Langley, Ivor ORCID: https://orcid.org/0000-0002-9275-6731, Fujiwara, P.I., Squire, Bertie ORCID: https://orcid.org/0000-0001-7173-9038, Oliveira, M.M, Kritski, A.L. and Rede-TB Study group, . (2017) 'Outcomes from patients with presumed drug resistant tuberculosis in five reference centers in Brazil'. BMC Infectious Diseases, Vol 17, e571.

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Abstract

Background

The 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.

Methods

Observational 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.

Results

Between 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).

Conclusions

This 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.

Item Type: Article
Subjects: WF Respiratory System > Tuberculosis > WF 200 Tuberculosis (General)
WF Respiratory System > Tuberculosis > WF 220 Diagnosis. Prognosis
WF Respiratory System > Tuberculosis > WF 360 Drug therapy
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI): https://doi.org/10.1186/s12879-017-2669-1
Depositing User: Kelly Smyth
Date Deposited: 18 Aug 2017 14:47
Last Modified: 18 Aug 2017 14:47
URI: http://archive.lstmed.ac.uk/id/eprint/7495

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