Abstract
BackgroundThe increased incidence of drug-resistant TB is a major challenge for effective TB control. Limited therapeutic options and poor treatment outcomes of DR-TB may increase drug-resistance rates. The objective of the study is to retrospectively compare MDR-TB and pre-XDR-TB treatment regimens and outcomes in two large TB reference centres in Italy from January 2000 to January 2015.MethodsA retrospective, multicentre study was conducted at the Regional TB Reference Centre Villa Marelli Institute (Milan) and at the Reference Center for MDR-TB and HIV-TB, Eugenio Morelli Hospital (Sondalo). The supra-national Reference Laboratory in Milan performed DST. Inclusion criteria were: age ≥ 18 and culture-confirmed diagnosis of MDR- or pre-XDR TB. Chi-square or Fisher exact test was used to detect differences in the comparison between treatment outcomes, therapeutic regimens, and drug-resistances. Computations were performed with STATA 15.ResultsA total of 134 patients were selected. Median (IQR) age at admission was 33 (26–41) years and 90 patients (67.2%) were male. Pulmonary TB was diagnosed in 124 (92.5%) patients. MDR- and pre-XDR-TB cases were 91 (67.9%) and 43 (32.1%), respectively. The WHO shorter MDR-TB regimen could have been prescribed in 16/84 (19.1%) patients. Treatment success was not statistically different between MDR- and pre-XDR-TB (81.3% VS. 81.4%; P = 0.99). Mortality in MDR-TB and pre-XDR-TB groups was 4.4 and 9.3%, respectively (P = 0.2). Median duration of treatment was 18 months and a total of 110 different regimens were administered. Exposure to linezolid, meropenem, and amikacin was associated with a better outcome in both groups (P = 0.001, P < 0.001, and P = 0.004, respectively).ConclusionsTailored treatment regimens based on DST results can achieve successful outcomes in patients with pre-XDR-TB.
Highlights
The increased incidence of drug-resistant TB is a major challenge for effective TB control
Even if globally TB mortality rate is decreasing at an annual rate of about 3%, the increased incidence of multi-drug-resistant TB (MDR-TB) represents a major challenge for effective TB control, undermining the goals of the End TB strategy for 2035 [2]
The World Health Organization (WHO) defines preextensively drug-resistant TB a TB form caused by Mycobacterium tuberculosis (MTB) strains with resistance to rifampicin (RMP), isoniazid (INH) (MDR-TB) and a second-line injectable agent (SLIs) or to any fluoroquinolone (FQ), whereas extensively drug-resistant TB (XDR-TB) is caused by a MTB strain resistant to INH, RMP, at least one Secondline injectable agent (SLIs) agent and to any FQ [3]
Summary
The increased incidence of drug-resistant TB is a major challenge for effective TB control. The objective of the study is to retrospectively compare MDR-TB and pre-XDR-TB treatment regimens and outcomes in two large TB reference centres in Italy from January 2000 to January 2015. Even if globally TB mortality rate is decreasing at an annual rate of about 3%, the increased incidence of multi-drug-resistant TB (MDR-TB) represents a major challenge for effective TB control, undermining the goals of the End TB strategy for 2035 [2]. 600,000 RMP-resistant (RR) and MDR-TB cases were estimated globally in 2016, epidemiology of pre- and XDR-TB is scarce [1]. A total of 2.8% (range: 1.8–4.3%) and 13% (range: 7.7–21%) of all new and previously treated TB cases showed drug resistance patterns in Italy, a low TB incidence country [1]
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