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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Drug resistance beyond extensively drugresistant tuberculosis: Individual patient data meta-analysis
European Respiratory Journal, Volume 42, No. 1, Year 2013
Notification
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Description
The broadest pattern of tuberculosis (TB) drug resistance for which a consensus definition exists is extensively drug-resistant (XDR)-TB. It is not known if additional drug resistance portends worsened patient outcomes. This study compares treatment outcomes of XDR-TB patients with and without additional resistance in order to explore the need for a new definition. Individual patient data on XDR-TB outcomes were included in a meta-analysis comparing outcomes between XDR alone and three nonmutually exclusive XDR-TB patient groups: XDR plus resistance to all the second-line injectables (sli) and capreomycin and kanamycin/amikacin (XDR+2sli) XDR plus resistance to second-line injectables and to more than one group 4 drug, i.e. ethionamide/protionamide, cycloserine/ terizidone or para-aminosalicylic acid (XDR+sliG4) and XDR+sliG4 plus resistance to ethambutol and/or pyrazinamide (XDR+sliG4EZ). Of 405 XDR-TB cases, 301 were XDR alone, 68 XDR+2sli, 48 XDR+sliG4 and 42 XDR+sliG4EZ. In multivariate analysis, the odds of cure were significantly lower in XDR+2sli (adjusted OR 0.4, 95%CI 0.2- 0.8) compared to XDR alone, while odds of failure and death were higher in all XDR patients with additional resistance (adjusted OR 2.6-2.8). Patients with additional resistance beyond XDR-TB showed poorer outcomes. Limitations in availability, accuracy and reproducibility of current drug susceptibility testing methods preclude the adoption of a useful definition beyond the one currently used for XDR-TB. Copyright © ERS 2013.
Authors & Co-Authors
Migliori, Giovanni Battista
Switzerland, Geneva
Organisation Mondiale de la Santé
Sotgiu, Giovanni
Italy, Sassari
Università Degli Studi Di Sassari
Gandhi, Neel R.
United States, New York
Albert Einstein College of Medicine of Yeshiva University
Falzon, Dennis
Switzerland, Geneva
Organisation Mondiale de la Santé
DeRiemer, Kathryn
United States, Davis
University of California, Davis
Centis, Rosella
Switzerland, Geneva
Organisation Mondiale de la Santé
Hollm-Delgado, Maria Graciela
Canada, Montreal
Mcgill University Health Centre, Montreal Chest Institute
Palmero, Domingo Juan
Argentina, Buenos Aires
Hospital de Infecciosas Francisco Javier Muniz
Pérez-Guzmán, Carlos
Mexico, Mexico
Instituto Mexicano Del Seguro Social
Vargas, Mario H.
Mexico, Mexico
Instituto Mexicano Del Seguro Social
D'Ambrosio, Lia
Switzerland, Geneva
Organisation Mondiale de la Santé
Spanevello, Antonio
Italy, Varese
Università Degli Studi Dell'insubria
Bauer, Melissa
Canada, Montreal
Mcgill University Health Centre, Montreal Chest Institute
Chan, Edward D.
United States
Va Medical Center
Schaaf, Hendrik Simon
South Africa, Stellenbosch
Stellenbosch University
Keshavjee, Salmaan A.
United States, Boston
Harvard Medical School
Holtz, Timothy H.
United States, Atlanta
Centers for Disease Control and Prevention
Richard (Dick), Menzies
Canada, Montreal
Mcgill University Health Centre, Montreal Chest Institute
Ahuja, Shama Desai
Unknown Affiliation
Ashkin, David
United States
Lantana
Avendaño, Mónica Arboleya
Unknown Affiliation
Banerjee, Ritu
Unknown Affiliation
Bayona, Jaime N.
Unknown Affiliation
Becerra, Mercedes C.
Unknown Affiliation
Benedetti, Andrea L.
Unknown Affiliation
Burgos, Marcos V.
Unknown Affiliation
Chiang, Chenyuan
Unknown Affiliation
Cox, Helen S.
Unknown Affiliation
Dung, Nguyen Huy
Unknown Affiliation
Enarson, Donald A.
Unknown Affiliation
Flanagan, Katie L.
Gambia
Fajara
Flood, Jennifer M.
Unknown Affiliation
García-García, Lourdes
Mexico
Cuernavaca
Granich, Reuben M.
Unknown Affiliation
Iseman, Michael D.
Unknown Affiliation
Jarlsberg, Leah G.
Unknown Affiliation
Kim, Hye-ryoun
Unknown Affiliation
Koh, Wonjung
Unknown Affiliation
Lancaster, Joey L.
Unknown Affiliation
Lange, Christoph G.
Unknown Affiliation
de Lange, Wiel C.M.
Unknown Affiliation
Leimane, Vaira
Latvia
Upeslejas
Leung, Chichiu
Unknown Affiliation
Li, Jiehui
Unknown Affiliation
Mishustin, Sergey P.
Unknown Affiliation
Mitnick, Carole Diane
Unknown Affiliation
Narita, M.
Unknown Affiliation
O'Riordan, Philly
United Kingdom, London
London
Pai, Madhukar
Unknown Affiliation
Park, Seungkyu
Unknown Affiliation
Pasvol, Geoffrey
United Kingdom, London
London
Peña, José María
Unknown Affiliation
Ponce-de-Leon, Alfredo
Mexico, Mexico City
Mexico City
Quelapio, Maria Imelda D.
Unknown Affiliation
Riekstiņa, Vieja
Unknown Affiliation
Robert, Jérome
Unknown Affiliation
Royce, Sarah E.
United Kingdom, London
London
Seung, Kwonjune J.
Unknown Affiliation
Shah, Lena
Unknown Affiliation
Shim, Tae-sun
Unknown Affiliation
Shin, Sonya Sunhi
Unknown Affiliation
Shiraishi, Yuji
Unknown Affiliation
Sifuentes-Osornio, José
Mexico, Mexico City
Mexico City
Strand, Matthew J.
Unknown Affiliation
Tabarsi, Payam
Unknown Affiliation
Tupasi, Thelma E.
Unknown Affiliation
van Altena, Richard
Unknown Affiliation
van der Walt, Martie L.
Unknown Affiliation
Van Derwerf, Tjip S.
Unknown Affiliation
Viiklepp, Piret
Unknown Affiliation
Westenhouse, Janice L.
Unknown Affiliation
Yew, Wing W.
Unknown Affiliation
Yim, Jae-joon
Unknown Affiliation
Statistics
Citations: 226
Authors: 73
Affiliations: 18
Identifiers
Doi:
10.1183/09031936.00136312
ISSN:
09031936
e-ISSN:
13993003
Research Areas
Health System And Policy
Infectious Diseases
Study Approach
Systematic review