Outcomes from patients with presumed drug resistant tuberculosis in five reference centers in Brazil

D. M.P. Ramalho; P. F.C. Miranda; M. K. Andrade; T. Brígido; M. P. Dalcolmo; E. Mesquita; C. F. Dias; A. N. Gambirasio; J. Ueleres Braga; A. Detjen; P. P.J. Phillips; I. Langley; P. I. Fujiwara; Bertie Squire; M. M. Oliveira; A. L. Kritski

doi:10.1186/s12879-017-2669-1

Outcomes from patients with presumed drug resistant tuberculosis in five reference centers in Brazil

D. M.P. Ramalho, P. F.C. Miranda, M. K. Andrade, T. Brígido, M. P. Dalcolmo, E. Mesquita, C. F. Dias, A. N. Gambirasio, J. Ueleres Braga, A. Detjen, P. P.J. Phillips, I. Langley, P. I. Fujiwara, Bertie Squire, M. M. Oliveira, A. L. Kritski

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9 Citations (Scopus)

Abstract

Background

The implementation of rapid drug susceptibility testing (DST) is a current global priority for TB control. However, data are scarce on patient-relevant outcomes for presumptive diagnosis of drug-resistant tuberculosis (pDR-TB) evaluated under field conditions in high burden countries.

Methods

Observational study of pDR-TB patients referred by primary and secondary health units. TB reference centers addressing DR-TB in five cities in Brazil. Patients age 18 years and older were eligible if pDR-TB, culture positive results for Mycobacterium tuberculosis and, if no prior DST results from another laboratory were used by a physician to start anti-TB treatment. The outcome measures were median time from triage to initiating appropriate anti-TB treatment, empirical treatment and, the treatment outcomes.

Results

Between February,16th, 2011 and February, 15th, 2012, among 175 pDR TB cases, 110 (63.0%) confirmed TB cases with DST results were enrolled. Among study participants, 72 (65.5%) were male and 62 (56.4%) aged 26 to 45 years. At triage, empirical treatment was given to 106 (96.0%) subjects. Among those, 85 were treated with first line drugs and 21 with second line. Median time for DST results was 69.5 [interquartile - IQR: 35.7–111.0] days and, for initiating appropriate anti-TB treatment, the median time was 1.0 (IQR: 0–41.2) days. Among 95 patients that were followed-up during the first 6 month period, 24 (25.3%; IC: 17.5%–34.9%) changed or initiated the treatment after DST results: 16/29 MDRTB, 5/21 DR-TB and 3/45 DS-TB cases. Comparing the treatment outcome to DS-TB cases, MDRTB had higher proportions changing or initiating treatment after DST results (p = 0.01) and favorable outcomes (p = 0.07).

Conclusions

This study shows a high rate of empirical treatment and long delay for DST results. Strategies to speed up the detection and early treatment of drug resistant TB should be prioritized.

Original language	English
Article number	571
Pages (from-to)	e571
Journal	BMC Infectious Diseases
Volume	17
Issue number	1
DOIs	https://doi.org/10.1186/s12879-017-2669-1
Publication status	Published - 15 Aug 2017

Keywords

Diagnosis
Multi-drug resistant tuberculosis
Treatment outcome

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Ramalho et al-2017-BMC Infectious DiseasesFinal published version, 547 KBLicence: CC BY

Cite this

Ramalho, D. M. P., Miranda, P. F. C., Andrade, M. K., Brígido, T., Dalcolmo, M. P., Mesquita, E., Dias, C. F., Gambirasio, A. N., Ueleres Braga, J., Detjen, A., Phillips, P. P. J., Langley, I., Fujiwara, P. I., Squire, B., Oliveira, M. M., & Kritski, A. L. (2017). Outcomes from patients with presumed drug resistant tuberculosis in five reference centers in Brazil. BMC Infectious Diseases, 17(1), e571. Article 571. https://doi.org/10.1186/s12879-017-2669-1

@article{7ac3594bccdf4494b6d0ab2fa55014d8,

title = "Outcomes from patients with presumed drug resistant tuberculosis in five reference centers in Brazil",

abstract = "BackgroundThe implementation of rapid drug susceptibility testing (DST) is a current global priority for TB control. However, data are scarce on patient-relevant outcomes for presumptive diagnosis of drug-resistant tuberculosis (pDR-TB) evaluated under field conditions in high burden countries.MethodsObservational study of pDR-TB patients referred by primary and secondary health units. TB reference centers addressing DR-TB in five cities in Brazil. Patients age 18 years and older were eligible if pDR-TB, culture positive results for Mycobacterium tuberculosis and, if no prior DST results from another laboratory were used by a physician to start anti-TB treatment. The outcome measures were median time from triage to initiating appropriate anti-TB treatment, empirical treatment and, the treatment outcomes.ResultsBetween February,16th, 2011 and February, 15th, 2012, among 175 pDR TB cases, 110 (63.0\%) confirmed TB cases with DST results were enrolled. Among study participants, 72 (65.5\%) were male and 62 (56.4\%) aged 26 to 45 years. At triage, empirical treatment was given to 106 (96.0\%) subjects. Among those, 85 were treated with first line drugs and 21 with second line. Median time for DST results was 69.5 [interquartile - IQR: 35.7–111.0] days and, for initiating appropriate anti-TB treatment, the median time was 1.0 (IQR: 0–41.2) days. Among 95 patients that were followed-up during the first 6 month period, 24 (25.3\%; IC: 17.5\%–34.9\%) changed or initiated the treatment after DST results: 16/29 MDRTB, 5/21 DR-TB and 3/45 DS-TB cases. Comparing the treatment outcome to DS-TB cases, MDRTB had higher proportions changing or initiating treatment after DST results (p = 0.01) and favorable outcomes (p = 0.07).ConclusionsThis study shows a high rate of empirical treatment and long delay for DST results. Strategies to speed up the detection and early treatment of drug resistant TB should be prioritized.",

keywords = "Diagnosis, Multi-drug resistant tuberculosis, Treatment outcome",

author = "Ramalho, \{D. M.P.\} and Miranda, \{P. F.C.\} and Andrade, \{M. K.\} and T. Br{\'i}gido and Dalcolmo, \{M. P.\} and E. Mesquita and Dias, \{C. F.\} and Gambirasio, \{A. N.\} and \{Ueleres Braga\}, J. and A. Detjen and Phillips, \{P. P.J.\} and I. Langley and Fujiwara, \{P. I.\} and Bertie Squire and Oliveira, \{M. M.\} and Kritski, \{A. L.\}",

year = "2017",

month = aug,

day = "15",

doi = "10.1186/s12879-017-2669-1",

language = "English",

volume = "17",

pages = "e571",

journal = "BMC Infectious Diseases",

issn = "1471-2334",

publisher = "BioMed Central Ltd",

number = "1",

}

Ramalho, DMP, Miranda, PFC, Andrade, MK, Brígido, T, Dalcolmo, MP, Mesquita, E, Dias, CF, Gambirasio, AN, Ueleres Braga, J, Detjen, A, Phillips, PPJ, Langley, I, Fujiwara, PI, Squire, B, Oliveira, MM & Kritski, AL 2017, 'Outcomes from patients with presumed drug resistant tuberculosis in five reference centers in Brazil', BMC Infectious Diseases, vol. 17, no. 1, 571, pp. e571. https://doi.org/10.1186/s12879-017-2669-1

TY - JOUR

T1 - Outcomes from patients with presumed drug resistant tuberculosis in five reference centers in Brazil

AU - Ramalho, D. M.P.

AU - Miranda, P. F.C.

AU - Andrade, M. K.

AU - Brígido, T.

AU - Dalcolmo, M. P.

AU - Mesquita, E.

AU - Dias, C. F.

AU - Gambirasio, A. N.

AU - Ueleres Braga, J.

AU - Detjen, A.

AU - Phillips, P. P.J.

AU - Langley, I.

AU - Fujiwara, P. I.

AU - Squire, Bertie

AU - Oliveira, M. M.

AU - Kritski, A. L.

PY - 2017/8/15

Y1 - 2017/8/15

N2 - BackgroundThe implementation of rapid drug susceptibility testing (DST) is a current global priority for TB control. However, data are scarce on patient-relevant outcomes for presumptive diagnosis of drug-resistant tuberculosis (pDR-TB) evaluated under field conditions in high burden countries.MethodsObservational study of pDR-TB patients referred by primary and secondary health units. TB reference centers addressing DR-TB in five cities in Brazil. Patients age 18 years and older were eligible if pDR-TB, culture positive results for Mycobacterium tuberculosis and, if no prior DST results from another laboratory were used by a physician to start anti-TB treatment. The outcome measures were median time from triage to initiating appropriate anti-TB treatment, empirical treatment and, the treatment outcomes.ResultsBetween February,16th, 2011 and February, 15th, 2012, among 175 pDR TB cases, 110 (63.0%) confirmed TB cases with DST results were enrolled. Among study participants, 72 (65.5%) were male and 62 (56.4%) aged 26 to 45 years. At triage, empirical treatment was given to 106 (96.0%) subjects. Among those, 85 were treated with first line drugs and 21 with second line. Median time for DST results was 69.5 [interquartile - IQR: 35.7–111.0] days and, for initiating appropriate anti-TB treatment, the median time was 1.0 (IQR: 0–41.2) days. Among 95 patients that were followed-up during the first 6 month period, 24 (25.3%; IC: 17.5%–34.9%) changed or initiated the treatment after DST results: 16/29 MDRTB, 5/21 DR-TB and 3/45 DS-TB cases. Comparing the treatment outcome to DS-TB cases, MDRTB had higher proportions changing or initiating treatment after DST results (p = 0.01) and favorable outcomes (p = 0.07).ConclusionsThis study shows a high rate of empirical treatment and long delay for DST results. Strategies to speed up the detection and early treatment of drug resistant TB should be prioritized.

AB - BackgroundThe implementation of rapid drug susceptibility testing (DST) is a current global priority for TB control. However, data are scarce on patient-relevant outcomes for presumptive diagnosis of drug-resistant tuberculosis (pDR-TB) evaluated under field conditions in high burden countries.MethodsObservational study of pDR-TB patients referred by primary and secondary health units. TB reference centers addressing DR-TB in five cities in Brazil. Patients age 18 years and older were eligible if pDR-TB, culture positive results for Mycobacterium tuberculosis and, if no prior DST results from another laboratory were used by a physician to start anti-TB treatment. The outcome measures were median time from triage to initiating appropriate anti-TB treatment, empirical treatment and, the treatment outcomes.ResultsBetween February,16th, 2011 and February, 15th, 2012, among 175 pDR TB cases, 110 (63.0%) confirmed TB cases with DST results were enrolled. Among study participants, 72 (65.5%) were male and 62 (56.4%) aged 26 to 45 years. At triage, empirical treatment was given to 106 (96.0%) subjects. Among those, 85 were treated with first line drugs and 21 with second line. Median time for DST results was 69.5 [interquartile - IQR: 35.7–111.0] days and, for initiating appropriate anti-TB treatment, the median time was 1.0 (IQR: 0–41.2) days. Among 95 patients that were followed-up during the first 6 month period, 24 (25.3%; IC: 17.5%–34.9%) changed or initiated the treatment after DST results: 16/29 MDRTB, 5/21 DR-TB and 3/45 DS-TB cases. Comparing the treatment outcome to DS-TB cases, MDRTB had higher proportions changing or initiating treatment after DST results (p = 0.01) and favorable outcomes (p = 0.07).ConclusionsThis study shows a high rate of empirical treatment and long delay for DST results. Strategies to speed up the detection and early treatment of drug resistant TB should be prioritized.

KW - Diagnosis

KW - Multi-drug resistant tuberculosis

KW - Treatment outcome

U2 - 10.1186/s12879-017-2669-1

DO - 10.1186/s12879-017-2669-1

M3 - Article

SN - 1471-2334

VL - 17

SP - e571

JO - BMC Infectious Diseases

JF - BMC Infectious Diseases

IS - 1

M1 - 571

ER -

Outcomes from patients with presumed drug resistant tuberculosis in five reference centers in Brazil

Abstract

Keywords

UN SDGs

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