Drug resistance beyond extensively drugresistant tuberculosis: Individual patient data meta-analysis
Por:
Migliori G.B., Sotgiu G., Gandhi N.R., Falzon D., DeRiemer K., Centis R., Hollm-Delgado M.-G., Palmero D., Pérez-Guzmán C., Vargas M.H., D'Ambrosio L., Spanevello A., Bauer M., Chan E.D., Schaaf H.S., Keshavjee S., Holtz T.H., Menzies D., Ahuja S., Ashkin D., Avendano M., Banerjee R., Bayona J.N., Becerra M.C., Benedetti A., Burgos M., Chiang C.-Y., Cox H., Dung N.H., Enarson D., Flanagan K., Flood J., Garcia-Garcia L., Granich R.M., Iseman M.D., Jarlsberg L.G., Kim H.R., Koh W.J., Lancaster J., Lange C., De Lange W.C.M., Leimane V., Leung C.C., Li J., Mishustin S.P., Mitnick C.D., Narita M., O'Riordan P., Pai M., Park S.K., Pasvol G., Pena J., Ponce-De-Leon A., Quelapio M.I.D., Riekstina V., Robert J., Royce S., Seung K.J., Shah L., Shim T.S., Shin S.S., Shiraishi Y., Sifuentes-Osornio J., Strand M.J., Tabarsi P., Tupasi T.E., Van Altena R., Van Der Walt M., Van Der Werf T.S., Viiklepp P., Westenhouse J., Yew W.W., Yim J.J.
Publicada:
1 ene 2013
Resumen:
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.
Filiaciones:
Migliori G.B.:
World Health Organization Collaborating Centre for Tuberculosis and Lung Diseases, Fondazione S. Maugeri, Care and Research Institute, Tradate
Sotgiu G.:
Epidemiology and Medical Statistics Unit, Dept. of Biomedical Sciences, University of Sassari, Sassari
Gandhi N.R.:
Dept. of Medicine and Epidemiology and Population Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
Falzon D.:
Stop TB Dept., World Health Organization, Geneva, Switzerland
Geneva, Switzerland
DeRiemer K.:
School of Medicine, University of California Davis, Davis, CA
Centis R.:
World Health Organization Collaborating Centre for Tuberculosis and Lung Diseases, Fondazione S. Maugeri, Care and Research Institute, Tradate
Hollm-Delgado M.-G.:
Montreal Chest Institute, McGill University, Respiratory Epidemiology Unit, 3650 St. Urbain, Montreal, QC H2X 2P4, Canada
Palmero D.:
Pulmonology Division, Hospital F.J. Muñiz, Buenos Aires, Argentina
Pérez-Guzmán C.:
Instituto de Servicios de Salud del Estado de Aguascalientes, Unidad de Medicina Ambulatoria Aguascalientes, Instituto Mexicano del Seguro Social, Aguascalientes
Vargas M.H.:
Instituto Nacional de Enfermedades Respiratorias, Medical Research Unit in Respiratory Diseases, Instituto Mexicano del Seguro Social, Mexico City, Mexico
Mexico City, Mexico
D'Ambrosio L.:
World Health Organization Collaborating Centre for Tuberculosis and Lung Diseases, Fondazione S. Maugeri, Care and Research Institute, Tradate
Spanevello A.:
Università degli Studi dell'Insubria, Varese, Division of Pneumology, Fondazione S. Maugeri, Care and Research Institute, Tradate, Italy
Bauer M.:
Montreal Chest Institute, McGill University, Respiratory Epidemiology Unit, 3650 St. Urbain, Montreal, QC H2X 2P4, Canada
Chan E.D.:
Pulmonary Dept., Denver Veterans Affair Medical Center and National Jewish Health, Denver, CO
Schaaf H.S.:
Desmond Tutu TB Centre, Dept. of Paediatrics and Child Health, Faculty of Health Sciences, Tygerberg, South Africa
Keshavjee S.:
Dept. of Global Health and Social Medicine, Harvard Medical School, Boston, MA
Holtz T.H.:
Centers for Disease Control and Prevention, Atlanta, GA, United States
Menzies D.:
Montreal Chest Institute, McGill University, Respiratory Epidemiology Unit, 3650 St. Urbain, Montreal, QC H2X 2P4, Canada
Ahuja S.:
Long Island City, NY, United States
Ashkin D.:
Lantana, FL, United States
Avendano M.:
Toronto, ON, Canada
Banerjee R.:
Rochester, MN, United States
Bayona J.N.:
Hanover, NH, United States
Becerra M.C.:
Boston, MA, United States
Benedetti A.:
Montreal, QC, Canada
Burgos M.:
Albuquerque, NM, United States
Chiang C.-Y.:
Taipei, Taiwan
Cox H.:
Cape Town, South Africa
Dung N.H.:
Ho Chi Minh City, Viet Nam
Enarson D.:
Paris, France
Flanagan K.:
Fajara, Gambia
Flood J.:
Richmond, CA, United States
Garcia-Garcia L.:
Cuernavaca, Mexico
Granich R.M.:
Geneva, Switzerland
Iseman M.D.:
Denver, CO, United States
Jarlsberg L.G.:
San Francisco, CA, United States
Kim H.R.:
Seoul, South Korea
Koh W.J.:
Seoul, South Korea
Lancaster J.:
Pretoria, South Africa
Lange C.:
Borstel, Germany
De Lange W.C.M.:
Haren, Netherlands
Leimane V.:
Upeslejas, Latvia
Leung C.C.:
Hong Kong, Hong Kong
Li J.:
New York, NY, United States
Mishustin S.P.:
Tomsk, Russian Federation
Mitnick C.D.:
Boston, MA, United States
Narita M.:
Seattle, WA, United States
O'Riordan P.:
London, United Kingdom
Pai M.:
Montreal, QC, Canada
Park S.K.:
Masan City, South Korea
Pasvol G.:
London, United Kingdom
Pena J.:
Madrid, Spain
Ponce-De-Leon A.:
Mexico City, Mexico
Quelapio M.I.D.:
Makati, Philippines
Riekstina V.:
Tokyo, Japan
Robert J.:
Paris, France
Royce S.:
London, United Kingdom
Seung K.J.:
Boston, MA, United States
Shah L.:
Montreal, QC, Canada
Shim T.S.:
Masan City, South Korea
Shin S.S.:
Boston, MA, United States
Shiraishi Y.:
Tokyo, Japan
Sifuentes-Osornio J.:
Mexico City, Mexico
Strand M.J.:
Seattle, WA, United States
Tabarsi P.:
Tehran, Iran
Tupasi T.E.:
Makati, Philippines
Van Altena R.:
Groningen, Netherlands
Van Der Walt M.:
Madrid, Spain
Van Der Werf T.S.:
Groningen, Netherlands
Viiklepp P.:
Tallinn, Estonia
Westenhouse J.:
Richmond, CA, United States
Yew W.W.:
Tehran, Iran
Yim J.J.:
Masan City, South Korea
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