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
ISSN: 09031936
Editorial
EUROPEAN RESPIRATORY SOC JOURNALS LTD, 442 GLOSSOP RD, SHEFFIELD S10 2PX, ENGLAND, Reino Unido
Tipo de documento: Article
Volumen: 42 Número: 1
Páginas: 169-179
WOS Id: 000321603400020
ID de PubMed: 23060633
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