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Yao L, Wang B, Chen X, Liu Q, Sheng J, Liu X, Dai X, Jiang Y. The safety and efficacy of decortication for stage III drug-resistant tuberculous empyema. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2023; 37:ivad166. [PMID: 37812210 PMCID: PMC10629925 DOI: 10.1093/icvts/ivad166] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/15/2023] [Accepted: 10/06/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVES The goal of this study was to evaluate the safety and efficacy of decortication for stage III drug-resistant tuberculous empyema (TE). METHODS We analysed all patients with stage III TE who underwent decortication between March 2015 and October 2019 at Wuhan Pulmonary Hospital. The patients were divided into 2 groups according to drug-susceptibility testing of bronchoscopy lavage fluid, pleural effusion and tissue specimens, including a drug-resistant group and a drug-sensitive group. We collected and compared the preoperative, perioperative and postoperative data from the 2 groups to evaluate the safety and efficacy of decortication for stage III drug-resistant TE. RESULTS In total, 135 cases met the inclusion criteria and were enrolled, including 30 cases in the drug-resistant group and 105 cases in the drug-sensitive group. No deaths were recorded for the entire study population. Compared to the drug-sensitive group, the drug-resistant group had longer operation times (259.8 ± 78.4 min vs 187.2 ± 56.0 min, P = 0.00), a larger volume of intraoperative blood loss [300 (200,400) ml vs 200 (130, 300) ml, P = 0.00] and a higher intraoperative transfusion rate (5/30, 16.7% vs 4/105, 3.8%, P = 0.04). The rate of complications was significantly higher in the drug-resistant group (23; 76.7%) than in the drug-sensitive group (53; 50.5%) (P = 0.01). Recurrence was not reported in any of the patients. Twenty-three (76.7%) patients in the drug-resistant group and 90 (85.7%) patients in the drug-sensitive group recovered to an "excellent" level, and 3 cases in each group recovered to a "poor" level; there was no significant difference between the 2 groups in surgical effects (P = 0.21). CONCLUSIONS Decortication is a safe, effective and feasible option for patients with stage III drug-resistant TE, although the operation is difficult and risky.
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Affiliation(s)
- Li Yao
- Department of Surgery, Wuhan Pulmonary Hospital, 28, Baofeng Road, Qiaokou District, Wuhan, Hubei Province, 430000, China
| | - Bing Wang
- Department of Surgery, Wuhan Pulmonary Hospital, 28, Baofeng Road, Qiaokou District, Wuhan, Hubei Province, 430000, China
| | - Xianxiang Chen
- Department of Surgery, Wuhan Pulmonary Hospital, 28, Baofeng Road, Qiaokou District, Wuhan, Hubei Province, 430000, China
| | - Qibin Liu
- Department of Surgery, Wuhan Pulmonary Hospital, 28, Baofeng Road, Qiaokou District, Wuhan, Hubei Province, 430000, China
| | - Jian Sheng
- Department of Surgery, Wuhan Pulmonary Hospital, 28, Baofeng Road, Qiaokou District, Wuhan, Hubei Province, 430000, China
| | - Xiaoyu Liu
- Department of Surgery, Wuhan Pulmonary Hospital, 28, Baofeng Road, Qiaokou District, Wuhan, Hubei Province, 430000, China
| | - Xiyong Dai
- Department of Surgery, Wuhan Pulmonary Hospital, 28, Baofeng Road, Qiaokou District, Wuhan, Hubei Province, 430000, China
| | - Yuhui Jiang
- Department of Surgery, Wuhan Pulmonary Hospital, 28, Baofeng Road, Qiaokou District, Wuhan, Hubei Province, 430000, China
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Veziris N, Bernard C, Guglielmetti L, Le Du D, Marigot-Outtandy D, Jaspard M, Caumes E, Lerat I, Rioux C, Yazdanpanah Y, Tiotiu A, Lemaitre N, Brossier F, Jarlier V, Robert J, Sougakoff W, Aubry A. Rapid emergence of Mycobacterium tuberculosis bedaquiline resistance: lessons to avoid repeating past errors. Eur Respir J 2017; 49:13993003.01719-2016. [PMID: 28182568 DOI: 10.1183/13993003.01719-2016] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 10/29/2016] [Indexed: 11/05/2022]
Affiliation(s)
- Nicolas Veziris
- Sorbonne Universités, UPMC Univ Paris 06, Inserm, U1135, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France .,Centre National de Référence des Mycobactéries, Laboratoire de Bactériologie-Hygiène, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, APHP, Paris, France
| | - Christine Bernard
- Sorbonne Universités, UPMC Univ Paris 06, Inserm, U1135, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France.,Centre National de Référence des Mycobactéries, Laboratoire de Bactériologie-Hygiène, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, APHP, Paris, France
| | - Lorenzo Guglielmetti
- Sorbonne Universités, UPMC Univ Paris 06, Inserm, U1135, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France.,Centre National de Référence des Mycobactéries, Laboratoire de Bactériologie-Hygiène, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, APHP, Paris, France.,Sanatorium, Centre Hospitalier de Bligny, Briis-sous-Forges, France
| | - Damien Le Du
- Sanatorium, Centre Hospitalier de Bligny, Briis-sous-Forges, France
| | - Dhiba Marigot-Outtandy
- Sanatorium, Centre Hospitalier de Bligny, Briis-sous-Forges, France.,AP-HP, Hôpital Raymond Poincaré, Service de Médecine Aigue Spécialisée, Garches, France
| | - Marie Jaspard
- AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Service des Maladies Infectieuses et Tropicales, Paris, France
| | - Eric Caumes
- AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Service des Maladies Infectieuses et Tropicales, Paris, France
| | - Isabelle Lerat
- AP-HP, Hôpital Bichat, Services de Maladies Infectieuses et Tropicales, Paris, France
| | - Christophe Rioux
- AP-HP, Hôpital Bichat, Services de Maladies Infectieuses et Tropicales, Paris, France
| | - Yazdan Yazdanpanah
- AP-HP, Hôpital Bichat, Services de Maladies Infectieuses et Tropicales, Paris, France.,INSERM, IAME, UMR 1137, Paris, France.,Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France
| | - Angelica Tiotiu
- Dépt de pneumologie, CHU de Nancy, Vandœuvre-lès-Nancy, France
| | - Nadine Lemaitre
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR, 8204 - CIIL - Center for Infection and Immunity of Lille, Lille, France
| | - Florence Brossier
- Sorbonne Universités, UPMC Univ Paris 06, Inserm, U1135, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France.,Centre National de Référence des Mycobactéries, Laboratoire de Bactériologie-Hygiène, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, APHP, Paris, France
| | - Vincent Jarlier
- Sorbonne Universités, UPMC Univ Paris 06, Inserm, U1135, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France.,Centre National de Référence des Mycobactéries, Laboratoire de Bactériologie-Hygiène, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, APHP, Paris, France
| | - Jerome Robert
- Sorbonne Universités, UPMC Univ Paris 06, Inserm, U1135, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France.,Centre National de Référence des Mycobactéries, Laboratoire de Bactériologie-Hygiène, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, APHP, Paris, France
| | - Wladimir Sougakoff
- Sorbonne Universités, UPMC Univ Paris 06, Inserm, U1135, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France.,Centre National de Référence des Mycobactéries, Laboratoire de Bactériologie-Hygiène, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, APHP, Paris, France
| | - Alexandra Aubry
- Sorbonne Universités, UPMC Univ Paris 06, Inserm, U1135, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France.,Centre National de Référence des Mycobactéries, Laboratoire de Bactériologie-Hygiène, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, APHP, Paris, France
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Guglielmetti L, Jaspard M, Le Dû D, Lachâtre M, Marigot-Outtandy D, Bernard C, Veziris N, Robert J, Yazdanpanah Y, Caumes E, Fréchet-Jachym M. Long-term outcome and safety of prolonged bedaquiline treatment for multidrug-resistant tuberculosis. Eur Respir J 2016; 49:13993003.01799-2016. [DOI: 10.1183/13993003.01799-2016] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 10/24/2016] [Indexed: 11/05/2022]
Abstract
Bedaquiline, a recently approved drug for the treatment of multidrug-resistant tuberculosis (MDR-TB), is recommended for a duration of 24 weeks. There are scarce data on patients treated with this drug outside clinical trials.All MDR-TB patients who started treatment from January 1, 2011 to December 31, 2013 and received ≥30 days of bedaquiline were included in a multicentre observational cohort.Among 45 MDR-TB patients, 53% harboured isolates resistant to both fluoroquinolones and second-line injectables, and 38% harboured isolates resistant to one of these drug classes. Median bedaquiline treatment duration was 361 days and 33 patients (73%) received prolonged (>190 days) bedaquiline treatment. Overall, 36 patients (80%) had favourable outcome, five were lost to follow-up, three died, and one failed and acquired bedaquiline resistance. No cases of recurrence were reported. Severe and serious adverse events were recorded in 60% and 18% of patients, respectively. Values of Fridericia-corrected QT interval (QTcF) >500 ms were recorded in 11% of patients, but neither arrhythmias nor symptomatic cardiac side-effects occurred. Bedaquiline was discontinued in three patients following QTcF prolongation. No significant differences in outcomes or adverse events rates were observed between patients receiving standard and prolonged bedaquiline treatment.Bedaquiline-containing regimens achieved favourable outcomes in a large proportion of patients. Prolonged bedaquiline treatment was overall well tolerated in this cohort.
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Kim W, Lee KS, Kim HS, Koh WJ, Jeong BH, Chung MJ, Jang HW. CT and microbiologic follow-up in primary multidrug-resistant pulmonary tuberculosis. Acta Radiol 2016; 57:197-204. [PMID: 25759483 DOI: 10.1177/0284185115575196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 02/03/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Little attention has been paid to the initial and follow-up computed tomography (CT) features in primary multi-drug resistant tuberculosis (pMDR-TB) setting. PURPOSE To describe serial CT findings and clinical course of pMDR-TB with antibiotic treatment. MATERIAL AND METHODS For the last 10 years, 340 MDR-TB patients were managed in a tertiary referral hospital. Among them, we included 44 (27 men, 17 women; mean age, 40 years; age range, 20-81 years) pMDR-TB patients; 37 treated with chemotherapy only and seven treated with medical therapy plus surgery. CT findings were evaluated regarding tree-in-bud sign, acinar nodule, peribronchial, segmental or lobar consolidation and cavity, and their extent. Sputum negative conversion rates and serial CT scores were assessed. To compare changes in disease extent between initial and follow-up CT studies, paired t-test was performed. RESULTS Two most frequent patterns of lung abnormality were tree-in-bud sign (37 of 44, 84.1%) and acinar nodule (41 of 44, 93.2%). Among 37 patients treated with chemotherapy only, 36 showed negative sputum conversion within 3 months after second-line drug commencement, maintained for >12 months. The other seven undergoing surgery during medical treatment showed excellent outcome with negative conversion achieved within one month after surgery and maintained for >12 months. CT scores showed significant decrease on serial CT studies (P < 0.001) in all. CONCLUSION In pMDR-TB, two most frequent abnormal CT patterns are tree-in-bud sign and acinar nodule. In 98% of patients, negative sputum conversion is achieved, and CT score also shows decrease in extent after TB chemotherapy.
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Affiliation(s)
- Wooil Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyung Soo Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyun Su Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Won-Jung Koh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Byeong-Ho Jeong
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Myung Jin Chung
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hye Won Jang
- Department of Social and Preventive Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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