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Bacterial risk factors for treatment failure and relapse among patients with isoniazid resistant tuberculosis

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Thai, Phan Vuong Khac, Ha, Dang Thi Minh, Hanh, Nguyen Thi, Day, Jeremy, Dunstan, Sarah, Nhu, Nguyen Thi Quynh, Kiet, Vo Sy, Lan, Nguyen Huu, Dung, Nguyen Huy, Lan, Nguyen Thi Ngoc, Thuong, Nguyen Thuong, Lan, Nguyen Ngoc, Liễu, Phạm Thị Thúy, Hồng, Nguyễn Thị, Điệp, Đào Công, Thanh, Nguyễn Thị Kim, Hội, Nguyễn Văn, Nghĩa, Nguyễn Văn, Đại, Trương Ngọc, Minh, Hoàng Quang, Thơm, Nguyễn Văn, Farrar, Jeremy and Caws, Maxine ORCID: https://orcid.org/0000-0002-9109-350X (2018) 'Bacterial risk factors for treatment failure and relapse among patients with isoniazid resistant tuberculosis'. BMC Infectious Diseases, Vol 18, Issue 1.

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Abstract

Background
Drug resistant tuberculosis (TB) is increasing in prevalence worldwide. Treatment failure and relapse is known to be high for patients with isoniazid resistant TB treated with standard first line regimens. However, risk factors for unfavourable outcomes and the optimal treatment regimen for isoniazid resistant TB are unknown. This cohort study was conducted when Vietnam used the eight month first line treatment regimen and examined risk factors for failure/relapse among patients with isoniazid resistant TB.

Methods
Between December 2008 and June 2011 2090 consecutive HIV-negative adults (≥18 years of age) with new smear positive pulmonary TB presenting at participating district TB units in Ho Chi Minh City were recruited. Participants with isoniazid resistant TB identified by Microscopic Observation Drug Susceptibility (MODS) had extended follow-up for 2 years with mycobacterial culture to test for relapse. MGIT drug susceptibility testing confirmed 239 participants with isoniazid resistant, rifampicin susceptible TB. Bacterial and demographic factors were analysed for association with treatment failure and relapse.

Results
Using only routine programmatic sputum smear microscopy for assessment, (months 2, 5 and 8) 30/239 (12.6%) had an unfavourable outcome by WHO criteria. Thirty-nine patients were additionally detected with unfavourable outcomes during 2 year follow up, giving a total of 69/239 (28.9%) of isoniazid (INH) resistant cases with unfavourable outcome by 2 years of follow-up. Beijing lineage was the only factor significantly associated with unfavourable outcome among INH-resistant TB cases during 2 years of follow-up. (adjusted OR = 3.16 [1.54–6.47], P = 0.002).

Conclusion
One third of isoniazid resistant TB cases suffered failure/relapse within 2 years under the old eight month regimen. Over half of these cases were not identified by standard WHO recommended treatment monitoring. Intensified research on early identification and optimal regimens for isoniazid resistant TB is needed. Infection with Beijing genotype of TB is a significant risk factor for bacterial persistence on treatment resulting in failure/relapse within 2 years. The underlying mechanism of increased tolerance for standard drug regimens in Beijing genotype strains remains unknown.

Item Type: Article
Subjects: QV Pharmacology > Anti-Inflammatory Agents. Anti-Infective Agents. Antineoplastic Agents > QV 268 Antitubercular agents. Antitubercular antibiotics
QW Microbiology and Immunology > QW 4 General works. Classify here works on microbiology as a whole.
QW Microbiology and Immunology > QW 50 Bacteria (General). Bacteriology. Archaea
WF Respiratory System > Tuberculosis > WF 200 Tuberculosis (General)
WF Respiratory System > Tuberculosis > WF 360 Drug therapy
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI): https://doi.org/10.1186/s12879-018-3033-9
SWORD Depositor: JISC Pubrouter
Depositing User: Stacy Murtagh
Date Deposited: 12 Mar 2018 14:00
Last Modified: 12 Mar 2018 14:00
URI: http://archive.lstmed.ac.uk/id/eprint/8345

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