Treatment outcomes of patients with multidrug-resistant and extensively drug-resistant tuberculosis according to drug susceptibility testing to first- and second-line drugs: An individual patient data meta-analysis

Mayara L. Bastos, Hamidah Hussain, Karin Weyer, Lourdes Garcia-Garcia, V. Leimane, C. C. Leung, M. Narita, Jose M. Penã, A. Ponce-De-leon, K. J. Seung, Karen Shean, J. Sifuentes-Osornio, M. Van Der Walt, Tjip S. Van Der Werf, W. W. Yew, D. Menzies, S. D. Ahuja, D. Ashkin, M. Avendano, R. BanerjeeM. Bauer, J. N. Bayona, M. C. Becerra, A. Benedetti, M. Burgos, R. Centis, E. D. Chan, C. Y. Chiang, H. Cox, L. D'Ambrosio, K. Deriemer, N. H. Dung, D. Enarson, D. Falzon, K. Flanagan, J. Flood, M. L. Garcia-Garcia, N. Gandhi, R. M. Granich, M. G. Hollm-Delgado, T. H. Holtz, M. D. Iseman, L. G. Jarlsberg, S. Keshavjee, H. R. Kim, W. J. Koh, J. Lancaster, C. Lange, W. C.M. De Lange, J. Li, G. B. Migliori, S. P. Mishustin, C. D. Mitnick, P. O'Riordan, M. Pai, D. Palmero, S. K. Park, G. Pasvol, J. Pena, C. Pérez-Guzmán, M. I.D. Quelapio, V. Riekstina, J. Robert, S. Royce, H. S. Schaaf, L. Shah, T. S. Shim, S. S. Shin, Y. Shiraishi, G. Sotgiu, M. J. Strand, P. Tabarsi, T. E. Tupasi, R. Van Altena, T. S. Van Der Werf, M. H. Vargas, P. Viiklepp, J. Westenhouse, J. J. Yim

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103 引文 斯高帕斯(Scopus)

摘要

Background: Individualized treatment for multidrug-resistant (MDR) tuberculosis and extensively drugresistant (XDR) tuberculosis depends upon reliable and valid drug susceptibility testing (DST) for pyrazinamide, ethambutol, and second-line tuberculosis drugs. However, the reliability of these tests is uncertain, due to unresolved methodological issues. We estimated the association of DST results for pyrazinamide, ethambutol, and second-line drugs with treatment outcomes in patients with MDR tuberculosis and XDR tuberculosis.

Methods: We conducted an analysis of individual patient data assembled from 31 previously published cohort studies of patients with MDR and XDR tuberculosis.We used data on patients' clinical characteristics including DST results, treatment received, outcomes, and laboratory methods in each center.

Results: DST methods and treatment regimens used in different centers varied considerably. Among 8955 analyzed patients, in vitro susceptibility to individual drugs was consistently and significantly associated with higher odds of treatment success (compared with resistance to the drug), if that drug was used in the treatment regimen. Various adjusted and sensitivity analyses suggest that this was not explained by confounding. The adjusted odds of treatment success for ethambutol, pyrazinamide, and the group 4 drugs ranged from 1.7 to 2.3, whereas for secondline injectables and fluoroquinolones, odds ranged from 2.4 to 4.6.

Conclusions: DST for ethambutol, pyrazinamide, and second-line tuberculosis drugs appears to provide clinically useful information to guide selection of treatment regimens for MDR and XDR tuberculosis.

原文英語
頁(從 - 到)1364-1374
頁數11
期刊Clinical Infectious Diseases
59
發行號10
DOIs
出版狀態已發佈 - 十一月 15 2014
對外發佈

ASJC Scopus subject areas

  • 微生物學(醫學)
  • 傳染性疾病

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