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Kho S, Seung KJ, Huerga H, Bastard M, Khan PY, Mitnick CD, Rich ML, Islam S, Zhizhilashvili D, Yeghiazaryan L, Nikolenko EN, Zarli K, Adnan S, Salahuddin N, Ahmed S, Vargas ZHR, Bekele A, Shaimerdenova A, Tamirat M, Gelin A, Vilbrun SC, Hewison C, Khan U, Franke M. Sputum culture reversion in longer treatments with bedaquiline, delamanid, and repurposed drugs for drug-resistant tuberculosis. Nat Commun 2024; 15:3927. [PMID: 38724531 PMCID: PMC11082252 DOI: 10.1038/s41467-024-48077-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 04/19/2024] [Indexed: 05/12/2024] Open
Abstract
Sputum culture reversion after conversion is an indicator of tuberculosis (TB) treatment failure. We analyze data from the endTB multi-country prospective observational cohort (NCT03259269) to estimate the frequency (primary endpoint) among individuals receiving a longer (18-to-20 month) regimen for multidrug- or rifampicin-resistant (MDR/RR) TB who experienced culture conversion. We also conduct Cox proportional hazard regression analyses to identify factors associated with reversion, including comorbidities, previous treatment, cavitary disease at conversion, low body mass index (BMI) at conversion, time to conversion, and number of likely-effective drugs. Of 1,286 patients, 54 (4.2%) experienced reversion, a median of 173 days (97-306) after conversion. Cavitary disease, BMI < 18.5, hepatitis C, prior treatment with second-line drugs, and longer time to initial culture conversion were positively associated with reversion. Reversion was uncommon. Those with cavitary disease, low BMI, hepatitis C, prior treatment with second-line drugs, and in whom culture conversion is delayed may benefit from close monitoring following conversion.
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Affiliation(s)
- Sooyeon Kho
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | - Kwonjune J Seung
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
- Partners in Health, 800 Boylston Street Suite 300, Boston, MA, USA
| | | | | | - Palwasha Y Khan
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
- Interactive Research and Development Global, Singapore, Singapore
| | - Carole D Mitnick
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
- Partners in Health, 800 Boylston Street Suite 300, Boston, MA, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Michael L Rich
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
- Partners in Health, 800 Boylston Street Suite 300, Boston, MA, USA
| | | | | | | | | | - Khin Zarli
- Médecins sans Frontières, Yangon, Myanmar
| | - Sana Adnan
- Indus Hospital and Health Network, Karachi, Pakistan
| | | | - Saman Ahmed
- Interactive Research and Development, Karachi, Pakistan
| | | | - Amsalu Bekele
- Department of Internal Medicine, Tikur Anbessa Specialized Hospital and Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
| | | | | | | | - Stalz Charles Vilbrun
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | | | - Uzma Khan
- Interactive Research and Development Global, Singapore, Singapore
| | - Molly Franke
- Partners in Health, 800 Boylston Street Suite 300, Boston, MA, USA.
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
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Zhang G, Sun X, Fleming J, Ran F, Luo J, Chen H, Ju H, Wang Z, Zhao H, Wang C, Zhang F, Dai X, Yang X, Li C, Liu Y, Wang Y, Zhang X, Jiang Y, Wu Z, Bi L, Zhang H. Genetic factors associated with acquired phenotypic drug resistance and its compensatory evolution during tuberculosis treatment. Clin Microbiol Infect 2024; 30:637-645. [PMID: 38286176 DOI: 10.1016/j.cmi.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/15/2024] [Accepted: 01/22/2024] [Indexed: 01/31/2024]
Abstract
OBJECTIVES We elucidated the factors, evolution, and compensation of antimicrobial resistance (AMR) in Mycobacterium tuberculosis (MTB) isolates under dual pressure from the intra-host environment and anti-tuberculosis (anti-TB) drugs. METHODS This retrospective case-control study included 337 patients with pulmonary tuberculosis from 15 clinics in Tianjin, China, with phenotypic drug susceptibility testing results available for at least two time points between January 1, 2009 and December 31, 2016. Patients in the case group exhibited acquired AMR to isoniazid (INH) or rifampicin (RIF), while those in the control group lacked acquired AMR. The whole-genome sequencing (WGS) was conducted on 149 serial longitudinal MTB isolates from 46 patients who acquired or reversed phenotypic INH/RIF-resistance during treatment. The genetic basis, associated factors, and intra-host evolution of acquired phenotypic INH/RIF-resistance were elucidated using a combined analysis. RESULTS Anti-TB interruption duration of ≥30 days showed association with acquired phenotypic INH/RIF resistance (aOR = 2·2, 95% CI, 1·0-5·1) and new rpoB mutations (p = 0·024). The MTB evolution was 1·2 (95% CI, 1·02-1·38) single nucleotide polymorphisms per genome per year under dual pressure from the intra-host environment and anti-TB drugs. AMR-associated mutations occurred before phenotypic AMR appearance in cases with acquired phenotypic INH (10 of 16) and RIF (9 of 22) resistances. DISCUSSION Compensatory evolution may promote the fixation of INH/RIF-resistance mutations and affect phenotypic AMR. The TB treatment should be adjusted based on gene sequencing results, especially in persistent culture positivity during treatment, which highlights the clinical importance of WGS in identifying reinfection and AMR acquisition before phenotypic drug susceptibility testing.
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Affiliation(s)
- Guoqin Zhang
- Key Laboratory of RNA Biology, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China; Tianjin Center for Tuberculosis Control, Tianjin, China; University of Chinese Academy of Sciences, Beijing, China
| | - Xianhui Sun
- Key Laboratory of RNA Biology, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China; University of Chinese Academy of Sciences, Beijing, China
| | - Joy Fleming
- Key Laboratory of RNA Biology, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
| | - Fanlei Ran
- Key Laboratory of RNA Biology, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China; University of Chinese Academy of Sciences, Beijing, China
| | - Jianjun Luo
- Key Laboratory of RNA Biology, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
| | - Hong Chen
- Key Laboratory of RNA Biology, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
| | - Hanfang Ju
- Tianjin Center for Tuberculosis Control, Tianjin, China
| | - Zhirui Wang
- Tianjin Center for Tuberculosis Control, Tianjin, China
| | - Hui Zhao
- Tianjin Center for Tuberculosis Control, Tianjin, China
| | - Chunhua Wang
- Tianjin Center for Tuberculosis Control, Tianjin, China
| | - Fan Zhang
- Tianjin Center for Tuberculosis Control, Tianjin, China
| | - Xiaowei Dai
- Beijing Center for Disease Prevention and Control, Beijing, China
| | - Xinyu Yang
- Beijing Center for Disease Prevention and Control, Beijing, China
| | - Chuanyou Li
- Biobank of Beijing Chest Hospital, Beijing Tuberculosis and Thoracic Tumour Research Institute/Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Yi Liu
- Biobank of Beijing Chest Hospital, Beijing Tuberculosis and Thoracic Tumour Research Institute/Beijing Chest Hospital, Capital Medical University, Beijing, China
| | | | - Xilin Zhang
- Foshan Fourth People's Hospital, Foshan, China
| | - Yuan Jiang
- Shanghai Municipal Center for Disease Prevention and Control, Beijing, China
| | - Zhilong Wu
- Foshan Fourth People's Hospital, Foshan, China
| | - Lijun Bi
- Key Laboratory of RNA Biology, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China; Guangzhou National Laboratory, Guangzhou, China; University of Chinese Academy of Sciences, Beijing, China
| | - Hongtai Zhang
- Beijing Center for Disease Prevention and Control, Beijing, China.
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Salindri AD, Kipiani M, Lomtadze N, Tukvadze N, Avaliani Z, Blumberg HM, Masyn KE, Rothenberg RB, Kempker RR, Magee MJ. HIV co-infection increases the risk of post-tuberculosis mortality among persons who initiated treatment for drug-resistant tuberculosis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2023.05.19.23290190. [PMID: 37293036 PMCID: PMC10246159 DOI: 10.1101/2023.05.19.23290190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Little is known regarding the relationship between common comorbidities in persons with tuberculosis (TB) (including human immunodeficiency virus [HIV], diabetes, and hepatitis C virus [HCV]) with post-TB mortality. We conducted a retrospective cohort study among persons who initiated treatment for rifampicin-resistant and multi/extensively drug-resistant (RR and M/XDR) TB reported to the country of Georgia's TB surveillance during 2009-2017. Exposures included HIV serologic status, diabetes, and HCV status. Our outcome was all-cause post-TB mortality determined by cross-validating vital status with Georgia's death registry through November 2019. We estimated adjusted hazard rate ratios (aHR) and 95% confidence intervals (CI) of post-TB mortality among participants with and without comorbidities using cause-specific hazard regressions. Among 1032 eligible participants, 34 (3.3%) died during treatment and 87 (8.7%) died post-TB treatment. Among those who died post-TB treatment, the median time to death was 21 months (interquartile range 7-39) post-TB treatment. After adjusting for confounders, the hazard rates of post-TB mortality were higher among participants with HIV co-infection (aHR=3.74, 95%CI 1.77-7.91) compared to those without HIV co-infection. In our cohort, post-TB mortality occurred most commonly in the first three years post-TB treatment. Linkage to care for common TB comorbidities post-treatment may reduce post-TB mortality rates.
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Affiliation(s)
- Argita D. Salindri
- Department of Population Health Sciences, Georgia State University School of Public Health, Atlanta, GA, USA; and Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Maia Kipiani
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia; David Tvildiani Medical University, Tbilisi, Georgia; and The University of Georgia, Tbilisi, Georgia
| | - Nino Lomtadze
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia; David Tvildiani Medical University, Tbilisi, Georgia; and The University of Georgia, Tbilisi, Georgia
| | - Nestani Tukvadze
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia; and Department of Medicine, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | - Zaza Avaliani
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia; and European University, Tbilisi, Georgia
| | - Henry M. Blumberg
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA; Hubert Department of Global Health and Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Katherine E. Masyn
- Department of Population Health Sciences, Georgia State University School of Public Health, Atlanta, GA, USA, Atlanta, GA, USA
| | - Richard B. Rothenberg
- Department of Population Health Sciences, Georgia State University School of Public Health, Atlanta, GA, USA, Atlanta, GA, USA
| | - Russell R. Kempker
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Matthew J. Magee
- Hubert Department of Global Health and Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA; and Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Xia X. Horizontal Gene Transfer and Drug Resistance Involving Mycobacterium tuberculosis. Antibiotics (Basel) 2023; 12:1367. [PMID: 37760664 PMCID: PMC10526031 DOI: 10.3390/antibiotics12091367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/13/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023] Open
Abstract
Mycobacterium tuberculosis (Mtb) acquires drug resistance at a rate comparable to that of bacterial pathogens that replicate much faster and have a higher mutation rate. One explanation for this rapid acquisition of drug resistance in Mtb is that drug resistance may evolve in other fast-replicating mycobacteria and then be transferred to Mtb through horizontal gene transfer (HGT). This paper aims to address three questions. First, does HGT occur between Mtb and other mycobacterial species? Second, what genes after HGT tend to survive in the recipient genome? Third, does HGT contribute to antibiotic resistance in Mtb? I present a conceptual framework for detecting HGT and analyze 39 ribosomal protein genes, 23S and 16S ribosomal RNA genes, as well as several genes targeted by antibiotics against Mtb, from 43 genomes representing all major groups within Mycobacterium. I also included mgtC and the insertion sequence IS6110 that were previously reported to be involved in HGT. The insertion sequence IS6110 shows clearly that the Mtb complex participates in HGT. However, the horizontal transferability of genes depends on gene function, as was previously hypothesized. HGT is not observed in functionally important genes such as ribosomal protein genes, rRNA genes, and other genes chosen as drug targets. This pattern can be explained by differential selection against functionally important and unimportant genes after HGT. Functionally unimportant genes such as IS6110 are not strongly selected against, so HGT events involving such genes are visible. For functionally important genes, a horizontally transferred diverged homologue from a different species may not work as well as the native counterpart, so the HGT event involving such genes is strongly selected against and eliminated, rendering them invisible to us. In short, while HGT involving the Mtb complex occurs, antibiotic resistance in the Mtb complex arose from mutations in those drug-targeted genes within the Mtb complex and was not gained through HGT.
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Affiliation(s)
- Xuhua Xia
- Department of Biology, University of Ottawa, Ottawa, ON K1N 9A7, Canada; ; Tel.: +1-613-562-5718
- Ottawa Institute of Systems Biology, University of Ottawa, Ottawa, ON K1H 8M5, Canada
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Ong JJ, Lim A, Bradshaw C, Taylor-Robinson D, Unemo M, Horner PJ, Vickerman P, Zhang L. Cost-effectiveness of testing for Mycoplasma genitalium among men who have sex with men in Australia. Sex Transm Infect 2023; 99:398-403. [PMID: 36958826 DOI: 10.1136/sextrans-2022-055611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 01/23/2023] [Indexed: 03/25/2023] Open
Abstract
OBJECTIVES Mycoplasma genitalium (MG) disproportionately affects men who have sex with men (MSM). We determined the cost-effectiveness of different testing strategies for MG in MSM, taking a healthcare provider perspective. METHODS We used inputs from a dynamic transmission model of MG among MSM living in Australia in a decision tree model to evaluate the impact of four testing scenarios on MG incidence: (1) no one tested; (2) symptomatic MSM; (3) symptomatic and high-risk asymptomatic MSM; (4) all MSM. We calculated the incremental cost-effectiveness ratios (ICERs) using a willingness-to-pay threshold of $A30 000 per quality-adjusted life year (QALY) gained. We explored the impact of adding an antimicrobial resistance (AMR) tax (ie, additional cost per antibiotic consumed) to identify the threshold, whereby any testing for MG is no longer cost-effective. RESULTS Testing only symptomatic MSM is the most cost-effective (ICER $3677 per QALY gained) approach. Offering testing to all MSM is dominated (ie, higher costs and lower QALYs gained compared with other strategies). When the AMR tax per antibiotic given was above $150, any testing for MG was no longer cost-effective. CONCLUSION Testing only symptomatic MSM is the most cost-effective option, even when the potential costs associated with AMR are accounted for (up to $150 additional cost per antibiotic given). For pathogens like MG, where there are anticipated future costs related to AMR, we recommend models that test the impact of incorporating an AMR tax as they can change the results and conclusions of cost-effectiveness studies.
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Affiliation(s)
- Jason J Ong
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
- London School of Hygiene and Tropical Medicine, London, UK
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Aaron Lim
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Catriona Bradshaw
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | | | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and Other STIs, Örebro University, Orebro, Sweden
- Institute for Global Health, University College London, London, UK
| | - Paddy J Horner
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Lei Zhang
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, People's Republic of China
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Hu Y, Chi Y, Feng X, Yu F, Li H, Shang Y, Pan J, Pang Y. Comparison of the Diagnostic Performance of MeltPro and Next-Generation Sequencing in Determining Fluoroquinolone Resistance in Multidrug-Resistant Tuberculosis Isolates. J Mol Diagn 2023; 25:342-351. [PMID: 37208048 DOI: 10.1016/j.jmoldx.2023.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 12/20/2022] [Accepted: 02/09/2023] [Indexed: 05/21/2023] Open
Abstract
This study systematically investigated the performance of MeltPro and next-generation sequencing in the diagnosis of fluoroquinolone (FQ) resistance among multidrug-resistant tuberculosis patients and explored the relationship between nucleotide alteration and the level of phenotypic susceptibility to FQs. From March 2019 to June 2020, a feasibility and validation study with both MeltPro and next-generation sequencing was performed in 126 patients with multidrug-resistant tuberculosis. Using phenotypic drug susceptibility testing as the gold standard, 95.3% (82 of 86) of ofloxacin-resistant isolates were identified correctly by MeltPro. In addition, whole-genome sequencing was able to detect 83 phenotypically ofloxacin-resistant isolates. The isolates with an individual gyrB mutation outside the quinolone resistance-determining region (QRDR) had minimum inhibitory concentrations (MICs) of ≤2 μg/mL. Despite showing low MICs close to the breakpoint for isolates carrying only gyrA_Ala90Val, the combined mutation gyrB_Asp461Asn caused the ofloxacin MIC to be eight higher than that obtained in Mycobacterium tuberculosis (MTB) isolates with the Ala90Val mutation alone (median, 32 μg/mL; P = 0.038). Heteroresistance was observed in 12 of 88 isolates harboring mutations in the QRDRs. In conclusion, our data show that MeltPro and the whole-genome sequencing assay correctly can identify FQ resistance caused by mutations in the gyrA QRDR. The combined gyrB_Asp461Asn mutation may significantly decrease in vitro FQ susceptibility of MTB isolates with low-level-resistance-associated gyrA mutations.
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Affiliation(s)
- Yan Hu
- Tuberculosis Reference Laboratory, Chongqing Municipal Institute of Tuberculosis, Chongqing, China
| | - Yuqing Chi
- Department of Bacteriology and Immunology, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Xin Feng
- Tuberculosis Reference Laboratory, Chongqing Municipal Institute of Tuberculosis, Chongqing, China
| | - Fengping Yu
- Tuberculosis Reference Laboratory, Chongqing Municipal Institute of Tuberculosis, Chongqing, China
| | - Haoran Li
- Department of Bacteriology and Immunology, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Yuanyuan Shang
- Department of Bacteriology and Immunology, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Junhua Pan
- Department of Bacteriology and Immunology, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China.
| | - Yu Pang
- Department of Bacteriology and Immunology, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China.
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Alemu A, Bitew ZW, Diriba G, Gashu E, Seid G, Eshetu K, Kebede A, Gumi B. Incidence and predictors of acquired resistance to second-line antituberculosis drugs during the course of multi-drug resistant tuberculosis treatment: protocol for a systematic review and meta-analysis. BMJ Open 2023; 13:e070143. [PMID: 37019479 PMCID: PMC10083796 DOI: 10.1136/bmjopen-2022-070143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 03/30/2023] [Indexed: 04/07/2023] Open
Abstract
INTRODUCTION To date, acquired resistance to second-line antituberculosis drugs (SLDs) during multi-drug resistant tuberculosis (MDR-TB) treatment is becoming a public health concern. Different studies have assessed the incidence of acquired resistance to SLDs. However, the findings are inconsistent and there is limited global evidence. Thus, we are going to assess the incidence and predictors of acquired resistance to SLDs during MDR-TB treatment. METHODS AND ANALYSIS We designed this protocol following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Electronic databases and grey literature sources will be searched systematically for articles published up to 25 March 2023. Studies reporting the incidence and predictors of acquired resistance to SLDs in MDR-TB patients will be explored. The studies will be managed using Endnote X8 citation manager and a stepwise approach will be followed to select studies. Data will be summarised using Microsoft Excel 2016 spreadsheet. A Newcastle-Ottawa Scale quality assessment and cochrane risk-of-bias tools will be used to assess the study's quality. The authors will independently search databases, select studies, assess the study's quality and extract data. Data will be analysed using STATA V.17 software. We will estimate the pooled incidence of acquired resistance with 95% CI. In addition, the pooled effect measures (OR, HR, risk ratio) with their 95% CI will be estimated. Heterogeneity will be assessed using the I2 statistics. Publication bias will be assessed using funnel plot and Egger's test. A subgroup analysis will be conducted for the primary outcome (acquired resistance) per each study characteristics such as WHO regional category, country's TB/MDR-TB burden, data collection period and per the specific second-line anti-TB drug. ETHICS AND DISSEMINATION Since this study will be based on data extraction from published studies, ethical approval is not mandatory. The study will be published in peer-reviewed scientific journals and the findings will be presented at different scientific conferences. PROSPERO REGISTRATION NUMBER CRD42022371014.
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Affiliation(s)
- Ayinalem Alemu
- National Tuberculosis Reference Laboratory, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Zebenay Workneh Bitew
- Department of Pediatric Nursing, School of Nursing, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Getu Diriba
- National Tuberculosis Reference Laboratory, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Emebet Gashu
- Addis Ababa Health Bureau, Addis Ababa, Ethiopia
| | - Getachew Seid
- National Tuberculosis Reference Laboratory, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Abebaw Kebede
- Africa Centers for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Balako Gumi
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
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Zhu J, Liu J, Bao Z, Cao H, Wang S, Li X, Ning Z, Hoffner S, Hu Y, Davies Forsman L. Acquired drug resistance during the turnaround time for drug susceptibility testing impacts outcome of tuberculosis. Tuberculosis (Edinb) 2023; 140:102341. [PMID: 37086709 DOI: 10.1016/j.tube.2023.102341] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 03/29/2023] [Accepted: 04/03/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND The impacts of acquired resistance to first-line drugs other than rifampicin during turnaround time (TAT) for drug susceptibility testing (DST) on tuberculosis (TB) treatment are unclear. METHOD We performed a prospective cohort study to test acquired resistance to isoniazid, ethambutol and pyrazinamide during TAT for DST as risk factors for prolonged time to sputum culture conversion (SCC) and treatment failure in China. Participants included had a baseline DST result for a Mycobacterium tuberculosis (Mtb) isolate collected at TB diagnosis and a follow-up DST result for a Mtb isolate collected upon baseline DST results availability. Acquired drug resistance was identified by comparing baseline and follow-up DST results. RESULTS This study included 65 patients with acquired resistance Mtb isolates and 130 patients with consistent drug susceptibility profiles. Cox proportional hazard regression analysis demonstrated acquired isoniazid resistance (aHR 0.50, 95%CI: 0.29-0.85) and acquired pyrazinamide resistance (aHR 0.54, 95%CI: 0.36-0.81) were associated with prolonged time to SCC. Moreover, acquired isoniazid resistance (aOR 7.64, 95%CI: 2.39-16.08) and acquired pyrazinamide resistance (aOR 5.71, 95%CI: 2.31-14.12) were independently associated with treatment failure. CONCLUSION Acquired resistance to isoniazid and/or pyrazinamide during TAT for DST was associated with prolonged time to SCC as well as treatment failure.
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Affiliation(s)
- Jiahui Zhu
- Department of Virology, University of Helsinki, Helsinki, Finland
| | - Jia Liu
- The Fifth People's Hospital of Suzhou, Infectious Disease Hospital Affiliated to Soochow University, Suzhou, China
| | - Ziwei Bao
- The Fifth People's Hospital of Suzhou, Infectious Disease Hospital Affiliated to Soochow University, Suzhou, China
| | - Hong Cao
- Department of Tuberculosis Control, Zigong Center for Disease Control and Prevention, Zigong, China
| | - Sainan Wang
- School of Public Health and Key Laboratory of Public Health Safety, Fudan University, Shanghai, China
| | - Xuliang Li
- School of Public Health and Key Laboratory of Public Health Safety, Fudan University, Shanghai, China
| | - Zhu Ning
- Department of Tuberculosis Control, Zigong Center for Disease Control and Prevention, Zigong, China
| | - Sven Hoffner
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Yi Hu
- School of Public Health and Key Laboratory of Public Health Safety, Fudan University, Shanghai, China
| | - Lina Davies Forsman
- Department of Infectious Disease, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Division of Infectious Diseases, Karolinska Institutet, Solna, Sweden.
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The effect of undernutrition on sputum culture conversion and treatment outcomes among people with multidrug-resistant tuberculosis: a systematic review and meta-analysis. Int J Infect Dis 2023; 127:93-105. [PMID: 36481489 DOI: 10.1016/j.ijid.2022.11.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES We aimed to evaluate the effect of undernutrition on sputum culture conversion and treatment outcomes among people with multidrug-resistant tuberculosis (MDR-TB). METHODS We searched for publications in the Medline, Embase, Scopus, and Web of Science databases. We conducted a random-effect meta-analysis to estimate the effects of undernutrition on sputum culture conversion and treatment outcomes. Hazard ratio (HR) for sputum culture conversion and odds ratio (OR) for end-of-treatment outcomes, with 95% CI, were used to summarize the effect estimates. Potential publication bias was checked using funnel plots and Egger's tests. RESULTS Of the 2358 records screened, 63 studies comprising a total of 31,583 people with MDR-TB were included. Undernutrition was significantly associated with a longer time to sputum culture conversion (HR 0.7, 95% CI 0.6-0.9, I2 = 67·1%), and a higher rate of mortality (OR 2.8, 95% CI 2.1-3.6, I2 = 21%) and unsuccessful treatment outcomes (OR 1.8, 95% CI 1.5-2.1, I2 = 70%). There was no significant publication bias in the included studies. CONCLUSION Undernutrition was significantly associated with unsuccessful treatment outcomes, including mortality and longer time to sputum culture conversion among people with MDR-TB. These findings have implications for supporting targeted nutritional interventions alongside standardized TB drugs.
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Garcia PK, Martinez Borrero R, Annamalai T, Diaz E, Balarezo S, Tiwari PB, Tse-Dinh YC. Localization of Mycobacterium tuberculosis topoisomerase I C-terminal sequence motif required for inhibition by endogenous toxin MazF4. Front Microbiol 2022; 13:1032320. [PMID: 36545199 PMCID: PMC9760754 DOI: 10.3389/fmicb.2022.1032320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/17/2022] [Indexed: 12/08/2022] Open
Abstract
Only about half the multi-drug resistant tuberculosis (MDR-TB) cases are successfully cured. Thus, there is an urgent need of new TB treatment against a novel target. Mycobacterium tuberculosis (Mtb) topoisomerase I (TopA) is the only type IA topoisomerase in this organism and has been validated as an essential target for TB drug discovery. Toxin-antitoxin (TA) systems participate as gene regulators within bacteria. The TA systems contribute to the long-term dormancy of Mtb within the host-cell environment. Mtb's toxin MazF4 (Rv1495) that is part of the MazEF4 TA system has been shown to have dual activities as endoribonuclease and topoisomerase I inhibitor. We have developed a complementary assay using an Escherichia coli strain with temperature-sensitive topA mutation to provide new insights into the MazF4 action. The assay showed that E. coli is not sensitive to the endoribonuclease activity of Mtb MazF4 but became vulnerable to MazF4 growth inhibition when recombinant Mtb TopA relaxation activity is required for growth. Results from the complementation by Mtb TopA mutants with C-terminal deletions showed that the lysine-rich C-terminal tail is required for interaction with MazF4. Site-directed mutagenesis is utilized to identify two lysine residues within a conserved motif in this C-terminal tail that are critical for MazF4 inhibition. We performed molecular dynamics simulations to predict the Mtb TopA-MazF4 complex. Our simulation results show that the complex is stabilized by hydrogen bonds and electrostatic interactions established by residues in the TopA C-terminal tail including the two conserved lysines. The mechanism of Mtb TopA inhibition by MazF4 could be useful for the discovery of novel inhibitors against a new antibacterial target in pathogenic mycobacteria for treatment of both TB and diseases caused by the non-tuberculosis mycobacteria (NTM).
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Affiliation(s)
- Pamela K. Garcia
- Department of Chemistry and Biochemistry, Florida International University, Miami, FL, United States
| | | | - Thirunavukkarasu Annamalai
- Department of Chemistry and Biochemistry, Florida International University, Miami, FL, United States,Biomolecular Sciences Institute, Florida International University, Miami, FL, United States
| | - Esnel Diaz
- Department of Chemistry and Biochemistry, Florida International University, Miami, FL, United States
| | - Steve Balarezo
- Department of Chemistry and Biochemistry, Florida International University, Miami, FL, United States
| | | | - Yuk-Ching Tse-Dinh
- Department of Chemistry and Biochemistry, Florida International University, Miami, FL, United States,Biomolecular Sciences Institute, Florida International University, Miami, FL, United States,*Correspondence: Yuk-Ching Tse-Dinh,
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11
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Vashakidze SA, Chandrakumaran A, Japaridze M, Gogishvili G, Collins JM, Rekhviashvili M, Kempker RR. A case report of persistent drug-sensitive pulmonary tuberculosis after treatment completion. BMC Infect Dis 2022; 22:864. [PMID: 36401164 PMCID: PMC9675100 DOI: 10.1186/s12879-022-07836-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/02/2022] [Indexed: 11/21/2022] Open
Abstract
Background Mycobacterium tuberculosis (Mtb) has been found to persist within cavities in patients who have completed their anti-tuberculosis therapy. The clinical implications of Mtb persistence after therapy include recurrence of disease and destructive changes within the lungs. Data on residual changes in patients who completed anti-tuberculosis therapy are scarce. This case highlights the radiological and pathological changes that persist after anti-tuberculosis therapy completion and the importance of achieving sterilization of cavities in order to prevent these changes. Case presentation This is a case report of a 33 year old female with drug-sensitive pulmonary tuberculosis who despite successfully completing standard 6-month treatment had persistent changes in her lungs on radiological imaging. The patient underwent multiple adjunctive surgeries to resect cavitary lesions, which were culture positive for Mtb. After surgical treatment, the patient’s chest radiographies improved, symptoms subsided, and she was given a definition of cure. Conclusions Medical therapy alone, in the presence of severe cavitary lung lesions may not be able to achieve sterilizing cure in all cases. Cavities can not only cause reactivation but also drive inflammatory changes and subsequent lung damage leading to airflow obstruction, bronchiectasis, and fibrosis. Surgical removal of these foci of bacilli can be an effective adjunctive treatment necessary for a sterilizing cure and improved long term lung health.
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Affiliation(s)
- Sergo A. Vashakidze
- grid.500650.60000 0004 4674 8591Thoracic Surgery Department, National Center for Tuberculosis and Lung Diseases, 50 Maruashvili, 0101 Tbilisi, Georgia ,grid.264978.60000 0000 9564 9822The University of Georgia, Tbilisi, Georgia
| | | | - Merab Japaridze
- grid.500650.60000 0004 4674 8591Thoracic Surgery Department, National Center for Tuberculosis and Lung Diseases, 50 Maruashvili, 0101 Tbilisi, Georgia
| | - Giorgi Gogishvili
- grid.500650.60000 0004 4674 8591Thoracic Surgery Department, National Center for Tuberculosis and Lung Diseases, 50 Maruashvili, 0101 Tbilisi, Georgia
| | - Jeffrey M. Collins
- grid.189967.80000 0001 0941 6502Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA USA
| | - Manana Rekhviashvili
- grid.500650.60000 0004 4674 8591Thoracic Surgery Department, National Center for Tuberculosis and Lung Diseases, 50 Maruashvili, 0101 Tbilisi, Georgia
| | - Russell R. Kempker
- grid.189967.80000 0001 0941 6502Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA USA
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12
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Kooti S, Abiri R, Kadivarian S, Khazayel S, Mohajeri P, Atashi S, Yari F, Ahmadpour H, Alvandi A. Modified gold nanoparticle colorimetric probe-based biosensor coupled with allele-specific PCR for rapid detection of G944C mutation associated with isoniazid resistance. SENSING AND BIO-SENSING RESEARCH 2022. [DOI: 10.1016/j.sbsr.2022.100543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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13
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Development and Optimization of a New UPLC-UV/MS Method through DoE and MLR for Detecting Substandard Drug Products to Treat Tuberculosis. Molecules 2022; 27:molecules27207141. [PMID: 36296733 PMCID: PMC9610718 DOI: 10.3390/molecules27207141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/13/2022] [Accepted: 10/18/2022] [Indexed: 11/05/2022] Open
Abstract
Drug products used for treating tuberculosis are one of the most widely reported medicines to be classified as falsified or substandard in low- and middle-income countries, representing a major hazard to health. The aim of this study was, firstly, to develop an ultra-performance liquid chromatography (UPLC) method which is able to analyze fixed combination tablets with up to four active pharmaceutical ingredients, including isoniazid, pyrazinamide, rifampicin, and ethambutol. Secondly, we aimed to optimize it through the design of experiments and multi-linear regression based on a central composite design and to validate it according to the guidelines of the International Conference on Harmonization. The application of this tools enabled the identification of the influential factors (flow rate, formic acid, and temperature) and their effects on the studied responses (retention factor and percentage for each drug) as part of the quality by design approach. The method proved to be to be linear in the range from 5.0 to 15 µg/mL for isoniazid, pyrazinamide, and rifampicin, being precise (<1%) and accurate (97−101%). In addition, the method validated for ethambutol proved to be linear from 1.4 to 4.2 µg/mL, as well as precise (0.54%) and accurate (97.3%). The method was stability indicated for all the active pharmaceutical ingredients studied and was able to detect two substandard formulations sampled on the African market.
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14
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Mutayoba BK, Ershova J, Lyamuya E, Hoelscher M, Heinrich N, Kilale AM, Range NS, Ngowi BJ, Ntinginya NE, Mfaume SM, Nkiligi E, Doulla B, Lyimo J, Kisonga R, Kingalu A, Lema Y, Kondo Z, Pletschette M. The second national anti-tuberculosis drug resistance survey in Tanzania, 2017-2018. Trop Med Int Health 2022; 27:891-901. [PMID: 36089572 PMCID: PMC9826299 DOI: 10.1111/tmi.13814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To determine the levels and patterns of resistance to first- and second-line anti-tuberculosis (TB) drugs among new and previously treated sputum smear positive pulmonary TB (PTB) patients. METHODS We conducted a nationally representative cross-sectional facility-based survey in June 2017-July 2018 involving 45 clusters selected based on probability proportional to size. The survey aimed to determine the prevalence of anti-TB drug resistance and associated risk factors among smear positive PTB patients in Tanzania. Sputum samples were examined using smear microscopy, Xpert MTB/RIF, culture and drug susceptibility testing (DST). Logistic regression was used to account for missing data and sampling design effects on the estimates and their standard errors. RESULTS We enrolled 1557 TB patients, including 1408 (90.4%) newly diagnosed and 149 (9.6%) previously treated patients. The prevalence of multidrug-resistant TB (MDR-TB) was 0.85% [95% confidence interval (CI): 0.4-1.3] among new cases and 4.6% (95% CI: 1.1-8.2) among previously treated cases. The prevalence of Mycobacterium tuberculosis strains resistant to any of the four first-line anti-TB drugs (isoniazid, rifampicin, streptomycin and ethambutol) was 1.7% among new TB patients and 6.5% among those previously treated. Drug resistance to all first-line drugs was similar (0.1%) in new and previously treated patients. None of the isolates displayed poly-resistance or extensively drug-resistant TB (XDR-TB). The only risk factor for MDR-TB was history of previous TB treatment (odds ratio = 5.7, 95% CI: 1.9-17.2). CONCLUSION The burden of MDR-TB in the country was relatively low with no evidence of XDR-TB. Given the overall small number of MDR-TB cases in this survey, it will be beneficial focusing efforts on intensified case detection including universal DST.
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Affiliation(s)
- Beatrice Kemilembe Mutayoba
- Department of Preventive ServicesMinistry of Health National AIDS Control ProgramDodomaTanzania,Department of Infectious Diseases and Tropical MedicineMedical Center of the University of MunichMunichGermany
| | - Julia Ershova
- Division of Global HIV and TB, Global TB BranchUS Centers for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Eligius Lyamuya
- Department of Microbiology and ImmunologyMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
| | - Michael Hoelscher
- Department of Infectious Diseases and Tropical MedicineMedical Center of the University of MunichMunichGermany
| | - Norbert Heinrich
- Department of Infectious Diseases and Tropical MedicineMedical Center of the University of MunichMunichGermany
| | - Andrew Martin Kilale
- Muhimbili Medical Research CentreNational Institute for Medical ResearchDar es SalaamTanzania
| | - Nyagosya Segere Range
- Muhimbili Medical Research CentreNational Institute for Medical ResearchDar es SalaamTanzania
| | - Benard James Ngowi
- Mbeya College of Health and Allied SciencesUniversity of Dar es SalaamMbeyaTanzania
| | | | - Saidi Mwinjuma Mfaume
- Muhimbili Medical Research CentreNational Institute for Medical ResearchDar es SalaamTanzania
| | - Emmanuel Nkiligi
- National Tuberculosis and Leprosy Program, Department of Preventive ServicesMinistry of HealthDodomaTanzania
| | - Basra Doulla
- National Tuberculosis and Leprosy ProgramCentral Tuberculosis Reference LaboratoryDar es SalaamTanzania
| | - Johnson Lyimo
- National Tuberculosis and Leprosy Program, Department of Preventive ServicesMinistry of HealthDodomaTanzania
| | - Riziki Kisonga
- Kibong'oto Infectious Diseases HospitalKilimanjaroTanzania
| | - Amri Kingalu
- National Tuberculosis and Leprosy Program, Department of Preventive ServicesMinistry of HealthDodomaTanzania
| | - Yakobo Lema
- Muhimbili Medical Research CentreNational Institute for Medical ResearchDar es SalaamTanzania
| | - Zuwena Kondo
- National Tuberculosis and Leprosy Program, Department of Preventive ServicesMinistry of HealthDodomaTanzania
| | - Michel Pletschette
- Department of Infectious Diseases and Tropical MedicineMedical Center of the University of MunichMunichGermany
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15
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Song WM, Li SJ, Liu JY, Fu Q, Xu TT, Tao NN, Zhang QY, Liu SQ, An QQ, Zhu XH, Liu Y, Yu CB, Li YF, Dong J, Li HC. Impact of alcohol drinking and tobacco smoking on the drug-resistance of newly diagnosed tuberculosis: a retrospective cohort study in Shandong, China, during 2004-2020. BMJ Open 2022; 12:e059149. [PMID: 35902191 PMCID: PMC9341182 DOI: 10.1136/bmjopen-2021-059149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To investigate the independent and collective impact of alcohol drinking and tobacco smoking on the drug-resistance of newly diagnosed tuberculosis (TB). DESIGN This was a retrospective cohort study. SETTING Shandong, China. PARTICIPANTS Patients with newly diagnosed TB from 1 January 2004 to 31 December 2020 were collected. Exclusive criteria: retreated cases; extrapulmonary tuberculosis; without information on drug susceptibility testing results, smoking or drinking habits; bacteriological identification as non-tuberculous mycobacteria. PRIMARY AND SECONDARY OUTCOME MEASURES Patients were classified into four groups including smokers only (G1), drinker only (G2), smoker +drinker (G3), non-smoker +non-drinker group (G0). We described the drug-resistant profiles, clinical factors and calculated the ORs of different drug-resistance among G1, G2, G3, compared with G0 through univariate and multivariate logistics regression models. RESULTS Of the 7996 TB cases enrolled, the proportions of G1, G2, G3 and G0 were 8.25%, 3.89%, 16.46% and 71.40%, respectively. The rates of drug-resistant (DR)-TB, mono-resistant TB, multidrug resistant (MDR)-TB, polydrug resistant TB in G1, G2, G3 and G0 were 19.24%/16.4%/17.33%/19.08%, 11.52%/8.68%/10.94%/11.63%, 3.03%/2.57%/2.96%/3.66% and 4.70%/4.82%/3.34%/ 4.08%, respectively. G3 had a higher risk of MDR1: isoniazid +rifampin (adjusted OR (aOR)=1.91, 95% CI: 1.036 to 3.532), but had a lower risk of DR-TB (aOR=0.84, 95% CI: 0.71 to 0.99), rifampin-related resistance (aOR=0.68, 95% CI: 0.49 to 0.93), streptomycin-related resistance (aOR=0.82, 95% CI: 0.68 to 0.99), ethambutol-related resistance (aOR=0.57, 95% CI: 0.34 to 0.95), MDR3: isoniazid +rifampin+streptomycin (aOR=0.41, 95% CI: 0.19 to 0.85), any isoniazid +streptomycin resistance (aOR=0.85, 95% CI: 0.71 to 1.00). However, there were no significant differences between G1 and G0, G2 and G0 in all drug-resistant subtypes. Those patients with cavity had a higher risk of DR-TB among G3 (OR=1.35, 95% CI: 1.01 to 1.81). CONCLUSION Although we did not found an independent impact of alcohol drinking or tobacco smoking on TB drug-resistance, respectively, these two habits had a combined effect on TB drug-resistance.
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Affiliation(s)
- Wan-Mei Song
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital, Jinan, Shandong, China
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Shi-Jin Li
- Department of Respiratory Medicine, Chengwu People's Hospital, Heze, Shandong, China
| | - Jin-Yue Liu
- Department of Medical Ultrasound, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Medicine and Health Key Laboratory of Abdominal Medical Imaging, Jinan, Shandong, China
| | - Qi Fu
- State Grid Shandong Electric Power Company, Jinan, Shandong, China
| | - Ting-Ting Xu
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital, Jinan, Shandong, China
| | - Ning Ning Tao
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital, Jinan, Shandong, China
| | - Qian-Yun Zhang
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital, Jinan, Shandong, China
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Si-Qi Liu
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital, Jinan, Shandong, China
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Qi-Qi An
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital, Jinan, Shandong, China
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Xue-Han Zhu
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital, Jinan, Shandong, China
| | - Yao Liu
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital, Jinan, Shandong, China
| | - Chun-Bao Yu
- Katharine Hsu International Research Center of Human Infectious Diseases, Shandong Provincial Chest Hospital, Jinan, Shandong, China
| | - Yi-Fan Li
- Department of Respiratory and Critical Care Medicine, The Third Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, China
| | - Jihua Dong
- Department of Respiratory Medicine, Heze Mudan People's Hospital, Heze, Shandong, China
| | - Huai-Chen Li
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital, Jinan, Shandong, China
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
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16
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You S, Chitwood MH, Gunasekera KS, Crudu V, Codreanu A, Ciobanu N, Furin J, Cohen T, Warren JL, Yaesoubi R. Predicting resistance to fluoroquinolones among patients with rifampicin-resistant tuberculosis using machine learning methods. PLOS DIGITAL HEALTH 2022; 1:e0000059. [PMID: 36177394 PMCID: PMC9518704 DOI: 10.1371/journal.pdig.0000059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Limited access to drug-susceptibility tests (DSTs) and delays in receiving DST results are challenges for timely and appropriate treatment of multi-drug resistant tuberculosis (TB) in many low-resource settings. We investigated whether data collected as part of routine, national TB surveillance could be used to develop predictive models to identify additional resistance to fluoroquinolones (FLQs), a critical second-line class of anti-TB agents, at the time of diagnosis with rifampin-resistant TB. Methods and findings We assessed three machine learning-based models (logistic regression, neural network, and random forest) using information from 540 patients with rifampicin-resistant TB, diagnosed using Xpert MTB/RIF and notified in the Republic of Moldova between January 2018 and December 2019. The models were trained to predict the resistance to FLQs based on demographic and TB clinical information of patients and the estimated district-level prevalence of resistance to FLQs. We compared these models based on the optimism-corrected area under the receiver operating characteristic curve (OC-AUC-ROC). The OC-AUC-ROC of all models were statistically greater than 0.5. The neural network model, which utilizes twelve features, performed best and had an estimated OC-AUC-ROC of 0.87 (0.83,0.91), which suggests reasonable discriminatory power. A limitation of our study is that our models are based only on data from the Republic of Moldova and since not externally validated, the generalizability of these models to other populations remains unknown. Conclusions Models trained on data from phenotypic surveillance of drug-resistant TB can predict resistance to FLQs based on patient characteristics at the time of diagnosis with rifampin-resistant TB using Xpert MTB/RIF, and information about the local prevalence of resistance to FLQs. These models may be useful for informing the selection of antibiotics while awaiting results of DSTs.
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Affiliation(s)
- Shiying You
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, United States of America
- Public Health Modeling Unit, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Melanie H. Chitwood
- Public Health Modeling Unit, Yale School of Public Health, New Haven, Connecticut, United States of America
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Kenneth S. Gunasekera
- Public Health Modeling Unit, Yale School of Public Health, New Haven, Connecticut, United States of America
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Valeriu Crudu
- Phthisiopneumology Institute, Chisinau, Republic of Moldova
| | | | - Nelly Ciobanu
- Phthisiopneumology Institute, Chisinau, Republic of Moldova
| | - Jennifer Furin
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio, United States of America
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Ted Cohen
- Public Health Modeling Unit, Yale School of Public Health, New Haven, Connecticut, United States of America
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Joshua L. Warren
- Public Health Modeling Unit, Yale School of Public Health, New Haven, Connecticut, United States of America
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Reza Yaesoubi
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, United States of America
- Public Health Modeling Unit, Yale School of Public Health, New Haven, Connecticut, United States of America
- * E-mail:
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17
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Evans EE, Avaliani T, Gujabidze M, Bakuradze T, Kipiani M, Sabanadze S, Smith AGC, Avaliani Z, Collins JM, Kempker RR. Long term outcomes of patients with tuberculous meningitis: The impact of drug resistance. PLoS One 2022; 17:e0270201. [PMID: 35749509 PMCID: PMC9232145 DOI: 10.1371/journal.pone.0270201] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 06/06/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Little is known about the impact of drug-resistance on clinical outcomes among patients with tuberculosis meningitis (TBM). METHODS A retrospective cohort study among patients treated for TBM in Tbilisi, Georgia. We performed medical chart abstraction to collect patient data. Long-term vital status was assessed using the Georgia National Death Registry. We utilized a Cox proportional-hazards model to evaluate the association of drug-resistance and mortality. RESULTS Among 343 TBM suspects, 237 had a presentation consistent with TBM. Drug resistance was suspected (n = 5) or confirmed (n = 31) in 36 patients including 30 with multidrug- or rifampin-resistance and 6 with isoniazid-resistance. Thirty-four patients had HIV. The median follow-up time was 1331 days (IQR, 852-1767). Overall, 73 of 237 (30%) people died with 50 deaths occurring during and 23 after treatment. The proportion of death was higher among patients with drug-resistant vs. drug-susceptible disease (67% vs. 24%, p<0.001) and with HIV versus no HIV (59% vs 27%, p<0.001). Mortality was significantly higher in patients with drug-resistant TBM after 90 days of treatment (aHR = 7.2, CI95% [3.6-14.3], p < 0.001). CONCLUSIONS Mortality was high among patients with drug-resistant TBM with many deaths occurring post treatment. More effective treatment options are urgently needed for drug-resistant TBM.
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Affiliation(s)
- Emily E. Evans
- Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Teona Avaliani
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
| | - Mariam Gujabidze
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
| | - Tinatin Bakuradze
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
| | - Maia Kipiani
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
| | - Shorena Sabanadze
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
| | - Alison G. C. Smith
- Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Zaza Avaliani
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
| | - Jeffrey M. Collins
- Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, Georgia, United States of America
| | - Russell R. Kempker
- Emory University School of Medicine, Atlanta, Georgia, United States of America
- Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, Georgia, United States of America
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18
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Micheni LN, Kassaza K, Kinyi H, Ntulume I, Bazira J. Detection of Mycobacterium tuberculosis multiple strains in sputum samples from patients with pulmonary tuberculosis in south western Uganda using MIRU-VNTR. Sci Rep 2022; 12:1656. [PMID: 35102181 PMCID: PMC8803872 DOI: 10.1038/s41598-022-05591-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 01/11/2022] [Indexed: 11/25/2022] Open
Abstract
Infections with multiple strains of Mycobacterium tuberculosis are now widely recognized as a common occurrence. Identification of patients infected with multiple strains provides both insight into the disease dynamics and the epidemiology of tuberculosis. Analysis of Mycobacterial Interspersed Repetitive Unit-Variable-Number Tandem Repeats (MIRU-VNTR) has been shown to be highly sensitive in detecting multiple M. tuberculosis strains even in sputum. The goal of this study was to identify cases of multiple M. tuberculosis strain infections among patients diagnosed with pulmonary tuberculosis in Southwestern Uganda and assessment of factors associated with multiple strain infections. DNA extracted directly from 78 sputum samples, each from an individual patient, was analyzed using the standard 24 loci MIRU-VNTR typing. Five (6.4%) of the 78 patients were infected with multiple strains of M. tuberculosis with all of them being the newly diagnosed cases while two-thirds of them were co-infected with HIV. Exact regression analysis projected that the natives were more likely to harbor multiple strains (OR; 0.981, 95% CI 0–7.926) as well as those with a high microbial load (OR; 0.390, 95% CI 0–3.8167). Despite these findings being not statistically significant due to the small sample size, this points to a critical component of disease dynamics that has clinical implications and emphasizes a need for a study using a larger cohort. It is also essential to study the potential factors associated with higher risk of exposure to newly diagnosed and HIV positive patients at the community level. In addition, our ability to detect multiple M. tuberculosis strains using the standard 24 loci MIRU-VNTR typing especially with allelic diversity in loci 2059 and 3171, which are excluded from the 15-locus MIRU-VNTR, lead us to recommend the use of this genotyping technique, especially in areas with tuberculosis endemicity similar to this study.
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Affiliation(s)
- Lisa Nkatha Micheni
- Department of Microbiology, Mbarara University of Science and Technology, Box 1410, Mbarara, Uganda. .,Department of Microbiology and Immunology, Kampala International University Western Campus, Box 71, Bushenyi, Uganda.
| | - Kennedy Kassaza
- Department of Microbiology, Mbarara University of Science and Technology, Box 1410, Mbarara, Uganda
| | - Hellen Kinyi
- Department of Biochemistry, School of Medicine, Kabale University, Box 317, Kabale, Uganda
| | - Ibrahim Ntulume
- Department of Microbiology and Immunology, Kampala International University Western Campus, Box 71, Bushenyi, Uganda
| | - Joel Bazira
- Department of Microbiology, Mbarara University of Science and Technology, Box 1410, Mbarara, Uganda.
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Wall DA, Tarrant SP, Wang C, Mills KV, Lennon CW. Intein Inhibitors as Novel Antimicrobials: Protein Splicing in Human Pathogens, Screening Methods, and Off-Target Considerations. Front Mol Biosci 2021; 8:752824. [PMID: 34692773 PMCID: PMC8529194 DOI: 10.3389/fmolb.2021.752824] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 09/24/2021] [Indexed: 01/20/2023] Open
Abstract
Protein splicing is a post-translational process by which an intervening polypeptide, or intein, catalyzes its own removal from the flanking polypeptides, or exteins, concomitant with extein ligation. Although inteins are highly abundant in the microbial world, including within several human pathogens, they are absent in the genomes of metazoans. As protein splicing is required to permit function of essential proteins within pathogens, inteins represent attractive antimicrobial targets. Here we review key proteins interrupted by inteins in pathogenic mycobacteria and fungi, exciting discoveries that provide proof of concept that intein activity can be inhibited and that this inhibition has an effect on the host organism's fitness, and bioanalytical methods that have been used to screen for intein activity. We also consider potential off-target inhibition of hedgehog signaling, given the similarity in structure and function of inteins and hedgehog autoprocessing domains.
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Affiliation(s)
- Diana A Wall
- Department of Chemistry, College of the Holy Cross, Worcester, MA, United States
| | - Seanan P Tarrant
- Department of Chemistry, College of the Holy Cross, Worcester, MA, United States
| | - Chunyu Wang
- Department of Biological Sciences, Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, NY, United States.,Department of Chemistry and Chemical Biology, Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, NY, United States
| | - Kenneth V Mills
- Department of Chemistry, College of the Holy Cross, Worcester, MA, United States
| | - Christopher W Lennon
- Department of Biological Sciences, Murray State University, Murray, KY, United States
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Vashakidze SA, Gogishvili SG, Nikolaishvili KG, Avaliani ZR, Chandrakumaran A, Gogishvili GS, Magee M, Blumberg HM, Kempker RR. Adjunctive surgery versus medical treatment among patients with cavitary multidrug-resistant tuberculosis. Eur J Cardiothorac Surg 2021; 60:1279-1285. [PMID: 34297819 DOI: 10.1093/ejcts/ezab337] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 06/15/2021] [Accepted: 06/17/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Surgical resection is recommended as adjunctive treatment for multidrug-resistant (MDR) tuberculosis (TB) in certain scenarios; however, data are limited. We sought to evaluate the impact of surgery by comparing TB outcomes among patients with cavitary disease who received medical versus combined medical and surgical treatment. METHODS A cohort of all patients with cavitary MDR or extensively drug-resistant (XDR) TB treated in Tbilisi, Georgia, between 2008 and 2012. Patients meeting indications for surgery underwent adjunctive resection in addition to medical treatment. We compared TB outcomes (proportions achieving cure/complete) among patients who received adjunctive surgery to those who received medical treatment alone using an adjusted robust Poisson regression. RESULTS Among 408 patients, 299 received medical treatment alone and 109 combined medical and surgical treatment. Patients in the non-surgical group were older and had higher rates of tobacco and alcohol use and bilateral disease compared to the surgical group. Patients in the surgical group had higher rates of XDR disease (28% vs 15%). Favourable outcomes were higher among the surgical versus non-surgical group cohort (76% vs 41%). After adjusting for multiple factors, the association between adjunctive resection and favourable outcome remained (adjusted risk ratio 1.6, 95% confidence interval 1.3-2.0); the relationship was also observed in secondary models that excluded patients with bilateral disease (contraindication for surgery) and patients receiving <6 months of treatment. Major postoperative complications occurred among 8 patients (7%) with no postoperative mortality. CONCLUSIONS Adjunctive surgery is safe and may improve the effectiveness of treatment among select patients with cavitary MDR- and XDR-TB.
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Affiliation(s)
- Sergo A Vashakidze
- Thoracic Surgery Department, National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia.,The University of Georgia, Tbilisi, Georgia
| | - Shota G Gogishvili
- Thoracic Surgery Department, National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
| | - Ketino G Nikolaishvili
- Thoracic Surgery Department, National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
| | - Zaza R Avaliani
- Thoracic Surgery Department, National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
| | | | - Giorgi Sh Gogishvili
- Thoracic Surgery Department, National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
| | - Mathew Magee
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Henry M Blumberg
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia Emory University, Atlanta, GA, USA
| | - Russell R Kempker
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia Emory University, Atlanta, GA, USA
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21
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Kuchukhidze G, Baliashvili D, Adamashvili N, Kasradze A, Kempker RR, Magee MJ. Long-Term Mortality and Active Tuberculosis Disease Among Patients Who Were Lost to Follow-Up During Second-Line Tuberculosis Treatment in 2011-2014: Population-Based Study in the Country of Georgia. Open Forum Infect Dis 2021; 8:ofab127. [PMID: 34189157 PMCID: PMC8231391 DOI: 10.1093/ofid/ofab127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 03/12/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND High rates of loss to follow-up (LFU) exist among patients with multidrug and extensively drug-resistant tuberculosis (M/XDR TB). We aimed to identify long-term clinical outcomes of patients who were LFU during second-line TB treatment. METHODS We conducted a follow-up study among adults who received second-line TB treatment in the country of Georgia during 2011-2014 with a final outcome of LFU. We attempted to interview all LFU patients, administered a structured questionnaire, and obtained sputum samples. Active TB at follow-up was defined by positive sputum Xpert-TB/RIF or culture. RESULTS Follow-up information was obtained for 461 patients. Among these patients, 107 (23%) died and 177 (38%) were contacted. Of those contacted, 123 (69%) consented to participate and 92 provided sputum samples. Thirteen (14%) had active TB with an estimated infectious time period for transmitting drug-resistant TB in the community of 480 days (interquartile range = 803). In multivariable analysis, positive culture at the time of LFU was associated with active TB at the time of our study (adjusted risk ratio = 13.3; 95% confidence interval, 4.2-42.2). CONCLUSIONS Approximately one quarter of patients on second-line TB treatment who were LFU died. Among those LFU evaluated in our study, 1 in 7 remained in the community with positive sputum cultures. To reduce death and transmission of disease, additional strategies are needed to encourage patients to complete treatment.
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Affiliation(s)
| | - Davit Baliashvili
- National Centre for Disease Control and Public Health, Tbilisi, Georgia
- Department of Epidemiology, Emory Rollins School of Public Health, Atlanta, Georgia, USA
| | | | - Ana Kasradze
- National Centre for Disease Control and Public Health, Tbilisi, Georgia
| | | | - Matthew J Magee
- Hubert Department of Global Health, Emory Rollins School of Public Health, Atlanta, Georgia, USA
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22
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Zhu J, Bao Z, Xie Y, Werngren J, Hu Y, Davies Forsman L, Bruchfeld J, Hoffner S. Additional drug resistance for Mycobacterium tuberculosis during turnaround time for drug-susceptibility testing in China: A multicenter observational cohort study. Int J Infect Dis 2021; 108:81-88. [PMID: 33862209 DOI: 10.1016/j.ijid.2021.04.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Although phenotypic drug susceptibility testing (DST) of Mycobacterium tuberculosis (Mtb) takes up to 6-8 weeks, little is known about how drug susceptibility is affected during this period. METHODS We performed a prospective cohort study to investigate the development of drug resistance (DR) during turnaround time (TAT), including 359 pulmonary tuberculosis (PTB) patients with a baseline DST result of an Mtb isolate collected at TB diagnosis and a follow-up DST result of an Mtb isolate collected when baseline DST result was available between 2013 and 2018. Whole-genome sequencing (WGS) was used to differentiate between acquired drug resistance, exogenous reinfection, and mixed infection. RESULTS Among the studied patients, during TAT for DST, 116 (32.3%) developed DR to four first-line drugs (rifampicin, isoniazid, pyrazinamide, ethambutol). Among 116 pairs of isolates included for WGS, 21 pairs were classified as acquired drug resistance with single nucleotide polymorphisms (SNPs) differences less than 12. Four pairs with an intermediate SNPs differences displayed minor differences in related genotypes and were assessed as mixed infection. The remaining 91 pairs had high SNPs differences consistent with exogenous reinfection. CONCLUSIONS The exogenous reinfection of drug-resistant strains played a vital role in the development of DR of Mtb isolates during TAT for DST, highlighting the need for both rapid DST methods and improved infection control.
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Affiliation(s)
- Jiahui Zhu
- School of Public Health and Key Laboratory of Public Health Safety, Fudan University, Shanghai, China
| | - Ziwei Bao
- The Fifth People's Hospital of Suzhou, Infectious Disease Hospital Affiliated to Soochow University, Suzhou, China
| | - Yan Xie
- Department Tuberculosis Control, Zigong Center for Disease Control and Prevention, Zigong, China
| | - Jim Werngren
- Department of Microbiology, The Public Health Agency of Sweden, Stockholm, Sweden
| | - Yi Hu
- School of Public Health and Key Laboratory of Public Health Safety, Fudan University, Shanghai, China.
| | - Lina Davies Forsman
- Department of Infectious Disease, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Division of Infectious Diseases, Karolinska Institutet Solna, Sweden
| | - Judith Bruchfeld
- Department of Infectious Disease, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Division of Infectious Diseases, Karolinska Institutet Solna, Sweden
| | - Sven Hoffner
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
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23
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van der Loo C, Bartie C, Barnard TG, Potgieter N. Detection of Free-Living Amoebae and Their Intracellular Bacteria in Borehole Water before and after a Ceramic Pot Filter Point-of-Use Intervention in Rural Communities in South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3912. [PMID: 33917870 PMCID: PMC8068299 DOI: 10.3390/ijerph18083912] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/26/2021] [Accepted: 04/02/2021] [Indexed: 11/21/2022]
Abstract
Free-living amoebae (FLA) are ubiquitous in nature, whereas amoeba-resistant bacteria (ARB) have evolved virulent mechanisms that allow them to resist FLA digestion mechanisms and survive inside the amoeba during hostile environmental conditions. This study assessed the prevalence of FLA and ARB species in borehole water before and after a ceramic point-of-use intervention in rural households. A total of 529 water samples were collected over a five-month period from 82 households. All water samples were subjected to amoebal enrichment, bacterial isolation on selective media, and molecular identification using 16S PCR/sequencing to determine ARB species and 18S rRNA PCR/sequencing to determine FLA species present in the water samples before and after the ceramic pot intervention. Several FLA species including Acanthamoeba spp. and Mycobacterium spp. were isolated. The ceramic pot filter removed many of these microorganisms from the borehole water. However, design flaws could have been responsible for some FLA and ARB detected in the filtered water. FLA and their associated ARB are ubiquitous in borehole water, and some of these species might be potentially harmful and a health risk to vulnerable individuals. There is a need to do more investigations into the health risk of these organisms after point-of-use treatment.
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Affiliation(s)
- Clarissa van der Loo
- Water and Health Research Centre, Faculty of Health Sciences, University of Johannesburg, Johannesburg 2094, South Africa; (C.v.d.L.); (T.G.B.)
| | | | - Tobias George Barnard
- Water and Health Research Centre, Faculty of Health Sciences, University of Johannesburg, Johannesburg 2094, South Africa; (C.v.d.L.); (T.G.B.)
| | - Natasha Potgieter
- Environmental Health, Domestic Hygiene and Microbial Pathogens Research Group, Department of Microbiology, University of Venda, Thohoyandou 1950, South Africa
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Association of rs12722 COL5A1 with pulmonary tuberculosis: a preliminary case-control study in a Kazakhstani population. Mol Biol Rep 2021; 48:691-699. [PMID: 33409715 DOI: 10.1007/s11033-020-06121-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 12/22/2020] [Indexed: 10/22/2022]
Abstract
Lung cavitation is the classic hallmark of TB, which facilitates the disease development and transmission. It involves the degradation of lung parenchyma which is mainly made up of collagen fibers by metalloproteinases (MMPs) produced by activated monocyte-derived cells, neutrophils and stromal cells. The following population-based preliminary case-control study of adults with TB (50) and controls (112) without TB was used to investigate possible association between rs1800012 in COL1A1, rs12722 in COL5A1 genes and pulmonary TB in Kazakhstan. We examined 162 samples (50 cases and 112 controls) to study the associations between TB disease status and demographic variables along with single nucleotide polymorphisms related to COLA1 and COL5A1. The unadjusted χ2 and multivariable logistic regression was performed to find out relationships between SNP and other predictors. Preliminary findings suggest that there is a statistically significant association of age (AOR = 0.97, 95% CI:0.94-0.99, p value = 0.049), social status (AOR = 2.41, 95% CI:1.16-5.02, p value = 0.018), HIV status (AOR = 7.12, 95% CI:1.90-26.7, p value = 0.004) and heterozygous rs12722 SNP (AOR = 2.47, 95% CI:1.17-5.19, p value = 0.018) polymorphism of COL5A1 gene with TB susceptibility. The association of collagen genes with TB pathogenesis indicates that anti TB programs can include development of new drug regimens that include MMP inhibitors which has been found to be helpful in collagen remodeling and repair. Therapeutic targeting of MMPs will prevent extracellular matrix and collagen degradation and granuloma maturation.
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25
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Soedarsono S, Mertaniasih NM, Sulistyowati T. FIRST LINE ANTI-TUBERCULOSIS DRUG RESISTANCE PATTERN IN MULTIDRUG-RESISTANT PULMONARY TUBERCULOSIS PATIENTS CORRELATE WITH ACID FAST BACILLI MICROSCOPY GRADING. INDONESIAN JOURNAL OF TROPICAL AND INFECTIOUS DISEASE 2020. [DOI: 10.20473/ijtid.v8i2.14294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Multidrug-resistant tuberculosis (MDR-TB) is a global public health crisis. Acid-fast bacilli (AFB) gradation in sputum examination is an important component in Pulmonary Tuberculosis (PTB) diagnosis and treatment outcome monitoring. Previously treated pulmonary TB patients with a higher AFB smear gradation may have higher rates of acquired resistance. Patients with a higher AFB grade indicate a higher bacillary load and had higher rates of acquired resistance. This study aims to evaluate the correlation between AFB gradation and first-line anti-TB drug resistance patterns in MDR pulmonary TB patients. This was a retrospective study conducted from August 2009 to April 2018 in Dr. Soetomo Hospital. Sputum samples were taken from MDR PTB patients. Sputum smear examination was done using Ziehl–Neelsen staining and gradation was measured according to IUATLD criteria. Samples with positive smear were evaluated for resistance patterns based on culture and resistance tests using the MGIT 960 BACTEC System. There were 433 sputum samples with AFB positive collected from MDR PTB patients. Resistance to RHES was found in 22 (14%) AFB +1, 19 (15%) AFB +2, and 29 (20%) AFB +3. Resistance to RHS was found in 22 (14%) AFB +1, 12 (9%) AFB +2, and 13 (9%) AFB +3. Resistance to RHE was found in 39 (25%) AFB +1, 38 (29%) AFB +2, and 35 (24%) AFB +3. Resistance to RH was found in 74 (47%) AFB +1, 61 (47%) AFB +2, and 69 (47%) AFB +3. Statistic analysis by Spearman test showed that there was no significant correlation between AFB gradation and first-line anti-TB drug resistance patterns. Acquired resistance to RHES can also found in lower bacillary load AFB +1.
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Detection of low-frequency resistance-mediating SNPs in next-generation sequencing data of Mycobacterium tuberculosis complex strains with binoSNP. Sci Rep 2020; 10:7874. [PMID: 32398743 PMCID: PMC7217866 DOI: 10.1038/s41598-020-64708-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 04/15/2020] [Indexed: 12/30/2022] Open
Abstract
Accurate drug resistance detection is key for guiding effective tuberculosis treatment. While genotypic resistance can be rapidly detected by molecular methods, their application is challenged by mixed mycobacterial populations comprising both susceptible and resistant cells (heteroresistance). For this, next-generation sequencing (NGS) based approaches promise the determination of variants even at low frequencies. However, accurate methods for a valid detection of low-frequency variants in NGS data are currently lacking. To tackle this problem, we developed the variant detection tool binoSNP which allows the determination of low-frequency single nucleotide polymorphisms (SNPs) in NGS datasets from Mycobacterium tuberculosis complex (MTBC) strains. By taking a reference-mapped file as input, binoSNP evaluates each genomic position of interest using a binomial test procedure. binoSNP was validated using in-silico, in-vitro, and serial patient isolates datasets comprising varying genomic coverage depths (100-500×) and SNP allele frequencies (1-30%). Overall, the detection limit for low-frequency SNPs depends on the combination of coverage depth and allele frequency of the resistance-associated mutation. binoSNP allows for valid detection of resistance associated SNPs at a 1% frequency with a coverage ≥400×. In conclusion, binoSNP provides a valid approach to detect low-frequency resistance-mediating SNPs in NGS data from clinical MTBC strains. It can be implemented in automated, end-user friendly analysis tools for NGS data and is a step forward towards individualized TB therapy.
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27
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Liu Q, Wei J, Li Y, Wang M, Su J, Lu Y, López MG, Qian X, Zhu Z, Wang H, Gan M, Jiang Q, Fu YX, Takiff HE, Comas I, Li F, Lu X, Fortune SM, Gao Q. Mycobacterium tuberculosis clinical isolates carry mutational signatures of host immune environments. SCIENCE ADVANCES 2020; 6:eaba4901. [PMID: 32524000 PMCID: PMC7259932 DOI: 10.1126/sciadv.aba4901] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/25/2020] [Indexed: 05/12/2023]
Abstract
Mycobacterium tuberculosis (Mtb) infection results in a spectrum of clinical and histopathologic manifestations. It has been proposed that the environmental and immune pressures associated with different contexts of infection have different consequences for the associated bacterial populations, affecting drug susceptibility and the emergence of resistance. However, there is little concrete evidence for this model. We prospectively collected sputum samples from 18 newly diagnosed and treatment-naïve patients with tuberculosis and sequenced 795 colony-derived Mtb isolates. Mutant accumulation rates varied considerably between different bacilli isolated from the same individual, and where high rates of mutation were observed, the mutational spectrum was consistent with reactive oxygen species-induced mutagenesis. Elevated bacterial mutation rates were identified in isolates from HIV-negative but not HIV-positive individuals, suggesting that they were immune-driven. These results support the model that mutagenesis of Mtb in vivo is modulated by the host environment, which could drive the emergence of variants associated with drug resistance in a host-dependent manner.
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Affiliation(s)
- Qingyun Liu
- Shanghai Public Health Clinical Center, Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS), Shanghai Medical College and School of Basic Medical Sciences, Fudan University, Shanghai, China
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
| | - Jianhao Wei
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Yawei Li
- CAS Key Laboratory of Genomic and Precision Medicine, Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing 100101, China
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Mei Wang
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Jun Su
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Yonghui Lu
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Mariana G. López
- Tuberculosis Genomic Unit, Instituto de Biomedicina de Valencia (IBV-CSIC), Valencia, Spain
| | - Xueqin Qian
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Zhaoqin Zhu
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Haiying Wang
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Mingyun Gan
- Molecular Medical Center, Children’s Hospital of Fudan University, Shanghai, China
| | - Qi Jiang
- Shanghai Public Health Clinical Center, Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS), Shanghai Medical College and School of Basic Medical Sciences, Fudan University, Shanghai, China
- Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Yun-Xin Fu
- Department of Biostatistics and Human Genetics Center, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Howard E. Takiff
- Integrated Mycobacterial Pathogenomics Unit, Institut Pasteur, Paris, France
- Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Iñaki Comas
- Tuberculosis Genomic Unit, Instituto de Biomedicina de Valencia (IBV-CSIC), Valencia, Spain
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Feng Li
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Xuemei Lu
- State Key Laboratory of Genetic Resources and Evolution, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming 650223, China
- CAS Center for Excellence in Animal Evolution and Genetics, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, 650223, China
| | - Sarah M. Fortune
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA 02139, USA
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Qian Gao
- Shanghai Public Health Clinical Center, Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS), Shanghai Medical College and School of Basic Medical Sciences, Fudan University, Shanghai, China
- Shenzhen Center for Chronic Disease Control, Shenzhen, China
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28
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Asay BC, Edwards BB, Andrews J, Ramey ME, Richard JD, Podell BK, Gutiérrez JFM, Frank CB, Magunda F, Robertson GT, Lyons M, Ben-Hur A, Lenaerts AJ. Digital Image Analysis of Heterogeneous Tuberculosis Pulmonary Pathology in Non-Clinical Animal Models using Deep Convolutional Neural Networks. Sci Rep 2020; 10:6047. [PMID: 32269234 PMCID: PMC7142129 DOI: 10.1038/s41598-020-62960-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 03/18/2020] [Indexed: 01/28/2023] Open
Abstract
Efforts to develop effective and safe drugs for treatment of tuberculosis require preclinical evaluation in animal models. Alongside efficacy testing of novel therapies, effects on pulmonary pathology and disease progression are monitored by using histopathology images from these infected animals. To compare the severity of disease across treatment cohorts, pathologists have historically assigned a semi-quantitative histopathology score that may be subjective in terms of their training, experience, and personal bias. Manual histopathology therefore has limitations regarding reproducibility between studies and pathologists, potentially masking successful treatments. This report describes a pathologist-assistive software tool that reduces these user limitations, while providing a rapid, quantitative scoring system for digital histopathology image analysis. The software, called 'Lesion Image Recognition and Analysis' (LIRA), employs convolutional neural networks to classify seven different pathology features, including three different lesion types from pulmonary tissues of the C3HeB/FeJ tuberculosis mouse model. LIRA was developed to improve the efficiency of histopathology analysis for mouse tuberculosis infection models, this approach has also broader applications to other disease models and tissues. The full source code and documentation is available from https://Github.com/TB-imaging/LIRA.
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Affiliation(s)
- Bryce C Asay
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, United States of America
| | - Blake Blue Edwards
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, United States of America
- Department of Computer Science, Colorado State University, Fort Collins, Colorado, United States of America
| | - Jenna Andrews
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, United States of America
| | - Michelle E Ramey
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, United States of America
| | - Jameson D Richard
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, United States of America
| | - Brendan K Podell
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, United States of America
| | - Juan F Muñoz Gutiérrez
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, United States of America
| | - Chad B Frank
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, United States of America
| | - Forgivemore Magunda
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, United States of America
| | - Gregory T Robertson
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, United States of America
| | - Michael Lyons
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, United States of America
| | - Asa Ben-Hur
- Department of Computer Science, Colorado State University, Fort Collins, Colorado, United States of America
| | - Anne J Lenaerts
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, United States of America.
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29
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Mikiashvili L, Kipiani M, Schechter MC, Avaliani Z, Kiria N, Kempker RR. Linezolid use for drug-resistant tuberculosis in Georgia: a retrospective cohort study. Int J Tuberc Lung Dis 2020; 24:436-443. [PMID: 32317069 PMCID: PMC7385591 DOI: 10.5588/ijtld.19.0444] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
SETTING: Data on the long-term use of linezolid (LZD) in the treatment of drug-resistant pulmonary tuberculosis (DR-PTB) are limited.OBJECTIVE: To assess safety, tolerability and efficacy of LZD-containing regimens for the treatment of DR-PTB in the country of Georgia.DESIGN: A retrospective study was conducted among DR-PTB patients receiving LZD 600 mg/day as part of newly implemented regimens (bedaquiline or delamanid, repurposed and second-line drugs) from July 2014 to October 2015 in programmatic conditions and following WHO recommendations.RESULTS: One hundred mostly male (82%) patients with a median age of 33 years received LZD. Most patients (77%) had previously been treated for TB; 57% had extensively drug-resistant TB. The median duration of LZD use was 503 days (interquartile range 355-616). LZD-associated adverse events occurred in 12 patients, leading to discontinuation in 4 (2 each due to peripheral neuropathy and cytopenias), and dose reduction to 300 mg/day in 6 cases (4 due to peripheral neuropathy and 2 for cytopenias). Almost all patients (95%) achieved culture conversion and 79% had a successful treatment outcomes.CONCLUSION: Treatment regimens including lengthy LZD use showed fairly good safety and tolerability and were associated with high rates of culture conversion and favorable outcomes.
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Affiliation(s)
- L Mikiashvili
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
| | - M Kipiani
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
| | - M C Schechter
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - Z Avaliani
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
| | - N Kiria
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
| | - R R Kempker
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
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30
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Abidi S, Achar J, Assao Neino MM, Bang D, Benedetti A, Brode S, Campbell JR, Casas EC, Conradie F, Dravniece G, du Cros P, Falzon D, Jaramillo E, Kuaban C, Lan Z, Lange C, Li PZ, Makhmudova M, Maug AKJ, Menzies D, Migliori GB, Miller A, Myrzaliev B, Ndjeka N, Noeske J, Parpieva N, Piubello A, Schwoebel V, Sikhondze W, Singla R, Souleymane MB, Trébucq A, Van Deun A, Viney K, Weyer K, Zhang BJ, Ahmad Khan F. Standardised shorter regimens versus individualised longer regimens for rifampin- or multidrug-resistant tuberculosis. Eur Respir J 2020; 55:13993003.01467-2019. [PMID: 31862767 DOI: 10.1183/13993003.01467-2019] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 12/04/2019] [Indexed: 11/05/2022]
Abstract
We sought to compare the effectiveness of two World Health Organization (WHO)-recommended regimens for the treatment of rifampin- or multidrug-resistant (RR/MDR) tuberculosis (TB): a standardised regimen of 9-12 months (the "shorter regimen") and individualised regimens of ≥20 months ("longer regimens").We collected individual patient data from observational studies identified through systematic reviews and a public call for data. We included patients meeting WHO eligibility criteria for the shorter regimen: not previously treated with second-line drugs, and with fluoroquinolone- and second-line injectable agent-susceptible RR/MDR-TB. We used propensity score matched, mixed effects meta-regression to calculate adjusted odds ratios and adjusted risk differences (aRDs) for failure or relapse, death within 12 months of treatment initiation and loss to follow-up.We included 2625 out of 3378 (77.7%) individuals from nine studies of shorter regimens and 2717 out of 13 104 (20.7%) individuals from 53 studies of longer regimens. Treatment success was higher with the shorter regimen than with longer regimens (pooled proportions 80.0% versus 75.3%), due to less loss to follow-up with the former (aRD -0.15, 95% CI -0.17- -0.12). The risk difference for failure or relapse was slightly higher with the shorter regimen overall (aRD 0.02, 95% CI 0-0.05) and greater in magnitude with baseline resistance to pyrazinamide (aRD 0.12, 95% CI 0.07-0.16), prothionamide/ethionamide (aRD 0.07, 95% CI -0.01-0.16) or ethambutol (aRD 0.09, 95% CI 0.04-0.13).In patients meeting WHO criteria for its use, the standardised shorter regimen was associated with substantially less loss to follow-up during treatment compared with individualised longer regimens and with more failure or relapse in the presence of resistance to component medications. Our findings support the need to improve access to reliable drug susceptibility testing.
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Affiliation(s)
- Syed Abidi
- McGill International TB Centre, Montreal, QC, Canada.,Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, McGill University and Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Jay Achar
- Médecins Sans Frontières/Doctors without Borders, London, UK
| | | | - Didi Bang
- International Reference Laboratory of Mycobacteriology, National Centre for Antimicrobials and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - Andrea Benedetti
- McGill International TB Centre, Montreal, QC, Canada.,Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, McGill University and Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,Dept of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Sarah Brode
- West Park Healthcare Centre, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Jonathon R Campbell
- McGill International TB Centre, Montreal, QC, Canada.,Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, McGill University and Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Esther C Casas
- Médecins Sans Frontières/Doctors without Borders, Amsterdam, The Netherlands
| | - Francesca Conradie
- Dept of Medicine, University of Witswatersrand, Johannesburg, South Africa
| | | | - Philipp du Cros
- Médecins Sans Frontières/Doctors without Borders, London, UK.,Burnet Institute, Melbourne, Australia
| | | | | | - Christopher Kuaban
- Faculty of Health Sciences, The University of Bamenda, Bambili, Cameroon
| | - Zhiyi Lan
- McGill International TB Centre, Montreal, QC, Canada.,Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, McGill University and Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Christoph Lange
- Research Center Borstel, Leibniz Lung Center, Borstel, Germany.,German Center for Infection Research Clinical TB Unit, Borstel, Germany.,Respiratory Medicine and International Health, University of Lübeck, Lübeck, Germany.,Dept of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Pei Zhi Li
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, McGill University and Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | | | | | - Dick Menzies
- McGill International TB Centre, Montreal, QC, Canada.,Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, McGill University and Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Giovanni Battista Migliori
- WHO Collaborating Centre for Tuberculosis and Lung Diseases, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
| | - Ann Miller
- Dept of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Bakyt Myrzaliev
- KNCV TB Foundation, Branch Office KNCV in Kyrgyzstan, Bishkek, Kyrgyzstan
| | - Norbert Ndjeka
- National TB Programme, Republic of South Africa, Pretoria, South Africa
| | | | | | - Alberto Piubello
- Damien Foundation, Brussels, Belgium.,International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Valérie Schwoebel
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Welile Sikhondze
- National TB Control Program, Eswatini Ministry of Health, Mbabane, Swaziland
| | - Rupak Singla
- National Institute of Tuberculosis and Respiratory Diseases, Delhi, India
| | | | - Arnaud Trébucq
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Armand Van Deun
- Mycobacteriology Unit, Institute of Tropical Medicine, Antwerp, Belgium
| | - Kerri Viney
- The University of Sydney, Sydney, Australia.,Karolinska Institutet, Stockholm, Sweden.,Australian National University, Canberra, Australia
| | - Karin Weyer
- World Health Organization, Geneva, Switzerland
| | - Betty Jingxuan Zhang
- McGill International TB Centre, Montreal, QC, Canada.,Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, McGill University and Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Faiz Ahmad Khan
- McGill International TB Centre, Montreal, QC, Canada .,Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, McGill University and Research Institute of the McGill University Health Centre, Montreal, QC, Canada
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31
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Shibabaw A, Gelaw B, Gebreyes W, Robinson R, Wang SH, Tessema B. The burden of pre-extensively and extensively drug-resistant tuberculosis among MDR-TB patients in the Amhara region, Ethiopia. PLoS One 2020; 15:e0229040. [PMID: 32053661 PMCID: PMC7018133 DOI: 10.1371/journal.pone.0229040] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 01/28/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The emergence of pre-extensively and extensively drug-resistant tuberculosis (Pre-XDR/XDR-TB) is the major hurdle for TB prevention and care programs especially in developing countries like Ethiopia. The less emphasis on universal access to laboratory techniques for the rapid diagnosis of TB and drug susceptibility testing (DST) makes the management of MDR-TB a challenge. Early detection of second line anti-TB drugs resistance is essential to reduce transmission of Pre-XDR/XDR-TB strains and adjusting the treatment regimen in MDR-TB. OBJECTIVE To determine the prevalence and resistance pattern of Pre-XDR- and XDR-TB among MDR-TB patients in the Amhara region, Ethiopia. METHODS A cross sectional study was carried out in nine MDR-TB treatment centers in the Amhara region. Sputum samples were collected from all pulmonary rifampicin resistant (RR) or MDR-TB patients prior to anti-TB treatment. Lӧwenstein-Jensen (LJ) culture, Ziehl Neelsen (ZN) smear, MTBDRplus and MTBDRsl assays were performed according to the standard procedures. Data were analyzed using SPSS 20 software. Chi-square and/or Fishers exact test was employed. RESULTS Overall, 6.3% of MDR-TB isolates were resistant to at least one second line drugs. Pre-XDR-TB and XDR-TB isolates accounted 5.7% and 0.6% respectively. Moreover, 3.4% were resistant to FQs and 3.4% were resistant to second line injectable drugs. All isolates were susceptible for low level kanamycin. Almost all pre-XDR-TB strains (90%) were previously treated with anti-TB drugs. Drug resistant Mycobacterium tuberculosis isolates were disproportionately distributed in districts of the Amhara region and the majorities were concentrated in urban areas. CONCLUSIONS The high proportion of MDR-TB patients resistant to at least one second line drug is alarming. Strengthening the laboratory facilities to monitor pre-XDR and XDR-TB patients is crucial. The TB programs need to give emphasis on the effective and rational use of second line drugs for newly diagnosed MDR-TB patients to prevent the emergence of pre-XDR/XDR-TB strains.
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Affiliation(s)
- Agumas Shibabaw
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Global One Health Initiative (GOHi), The Ohio State University, Columbus, Ohio, United States of America
- Department of Microbial Infection and Immunity, College of Medicine, The Ohio State University, Columbus, Ohio, United States of America
- * E-mail:
| | - Baye Gelaw
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Wondwossen Gebreyes
- Global One Health Initiative (GOHi), The Ohio State University, Columbus, Ohio, United States of America
- Department of Veterinary Preventive Medicine, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, United States of America
| | - Richard Robinson
- Department of Microbial Infection and Immunity, College of Medicine, The Ohio State University, Columbus, Ohio, United States of America
| | - Shu-Hua Wang
- Global One Health Initiative (GOHi), The Ohio State University, Columbus, Ohio, United States of America
- Department of Internal Medicine, Division of infectious diseases, College of Medicine, The Ohio State University, Columbus, Ohio, United States of America
| | - Belay Tessema
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Deshpande D, Pasipanodya JG, Srivastava S, Bendet P, Koeuth T, Bhavnani SM, Ambrose PG, Smythe W, McIlleron H, Thwaites G, Gumusboga M, Van Deun A, Gumbo T. Gatifloxacin Pharmacokinetics/Pharmacodynamics-based Optimal Dosing for Pulmonary and Meningeal Multidrug-resistant Tuberculosis. Clin Infect Dis 2019; 67:S274-S283. [PMID: 30496459 DOI: 10.1093/cid/ciy618] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Background Gatifloxacin is used for the treatment of multidrug-resistant tuberculosis (MDR-TB). The optimal dose is unknown. Methods We performed a 28-day gatifloxacin hollow-fiber system model of tuberculosis (HFS-TB) study in order to identify the target exposures associated with optimal kill rates and resistance suppression. Monte Carlo experiments (MCE) were used to identify the dose that would achieve the target exposure in 10000 adult patients with meningeal or pulmonary MDR-TB. The optimal doses identified were validated using probit analyses of clinical data from 2 prospective clinical trials of patients with pulmonary and meningeal tuberculosis. Classification and regression-tree (CART) analyses were used to identify the gatifloxacin minimum inhibitory concentration (MIC) below which patients failed or relapsed on combination therapy. Results The target exposure associated with optimal microbial kill rates and resistance suppression in the HFS-TB was a 0-24 hour area under the concentration-time curve-to-MIC of 184. MCE identified an optimal gatifloxacin dose of 800 mg/day for pulmonary and 1200 mg/day for meningeal MDR-TB, and a clinical susceptibility breakpoint of MIC ≤ 0.5 mg/L. In clinical trials, CART identified that 79% patients failed therapy if MIC was >2 mg/L, but 98% were cured if MIC was ≤0.5 mg/L. Probit analysis of clinical data demonstrated a >90% probability of a cure in patients if treated with 800 mg/day for pulmonary tuberculosis and 1200 mg/day for meningeal tuberculosis. Doses ≤400 mg/day were suboptimal. Conclusions Gatifloxacin doses of 800 mg/day and 1200 mg/day are recommended for pulmonary and meningeal MDR-TB treatment, respectively. Gatifloxacin has a susceptible dose-dependent zone at MICs 0.5-2 mg/L.
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Affiliation(s)
- Devyani Deshpande
- Center for Infectious Diseases Research and Experimental Therapeutics, Baylor Research Institute, Baylor University Medical Center, Dallas, Texas
| | - Jotam G Pasipanodya
- Center for Infectious Diseases Research and Experimental Therapeutics, Baylor Research Institute, Baylor University Medical Center, Dallas, Texas
| | - Shashikant Srivastava
- Center for Infectious Diseases Research and Experimental Therapeutics, Baylor Research Institute, Baylor University Medical Center, Dallas, Texas
| | - Paula Bendet
- Center for Infectious Diseases Research and Experimental Therapeutics, Baylor Research Institute, Baylor University Medical Center, Dallas, Texas
| | - Thearith Koeuth
- Center for Infectious Diseases Research and Experimental Therapeutics, Baylor Research Institute, Baylor University Medical Center, Dallas, Texas
| | | | - Paul G Ambrose
- Institute for Clinical Pharmacodynamics, Schenectady, New York
| | - Wynand Smythe
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Observatory, South Africa
| | - Helen McIlleron
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Observatory, South Africa
| | - Guy Thwaites
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, Churchill Hospital, Oxford, United Kingdom.,Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | - Armand Van Deun
- Institute of Tropical Medicine, Antwerp, Belgium.,International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Tawanda Gumbo
- Center for Infectious Diseases Research and Experimental Therapeutics, Baylor Research Institute, Baylor University Medical Center, Dallas, Texas
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33
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Li H, Chen T, Yu L, Guo H, Chen L, Chen Y, Chen M, Zhao J, Yan H, Zhou L, Wang W. Genome‐wide DNA methylation and transcriptome and proteome changes in
Mycobacterium tuberculosis
with para‐aminosalicylic acid resistance. Chem Biol Drug Des 2019; 95:104-112. [PMID: 31562690 DOI: 10.1111/cbdd.13625] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 09/09/2019] [Accepted: 09/21/2019] [Indexed: 12/26/2022]
Affiliation(s)
- Hai‐cheng Li
- Reference Laboratory Centre for Tuberculosis Control of Guangdong Province Guangzhou China
| | - Tao Chen
- Reference Laboratory Centre for Tuberculosis Control of Guangdong Province Guangzhou China
| | - Li Yu
- Reference Laboratory Centre for Tuberculosis Control of Guangdong Province Guangzhou China
| | - Hui‐xin Guo
- Reference Laboratory Centre for Tuberculosis Control of Guangdong Province Guangzhou China
| | - Liang Chen
- Centre for Tuberculosis Control of Guangdong Province Guangzhou China
| | - Yu‐hui Chen
- Outpatient Office Centre for Tuberculosis Control of Guangdong Province Guangzhou China
| | - Mu Chen
- Department of Respiration The Sixth Affiliated Hospital of Sun Yat‐sen University Guangzhou China
| | - Jiao Zhao
- Medical College of Jinan University Guangzhou China
| | | | - Lin Zhou
- Centre for Tuberculosis Control of Guangdong Province Guangzhou China
| | - Wei Wang
- The Forth People's Hospital of Foshan Foshan China
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Dheda K, Lenders L, Magombedze G, Srivastava S, Raj P, Arning E, Ashcraft P, Bottiglieri T, Wainwright H, Pennel T, Linegar A, Moodley L, Pooran A, Pasipanodya JG, Sirgel FA, van Helden PD, Wakeland E, Warren RM, Gumbo T. Drug-Penetration Gradients Associated with Acquired Drug Resistance in Patients with Tuberculosis. Am J Respir Crit Care Med 2019; 198:1208-1219. [PMID: 29877726 DOI: 10.1164/rccm.201711-2333oc] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Acquired resistance is an important driver of multidrug-resistant tuberculosis (TB), even with good treatment adherence. However, exactly what initiates the resistance and how it arises remain poorly understood. OBJECTIVES To identify the relationship between drug concentrations and drug susceptibility readouts (minimum inhibitory concentrations [MICs]) in the TB cavity. METHODS We recruited patients with medically incurable TB who were undergoing therapeutic lung resection while on treatment with a cocktail of second-line anti-TB drugs. On the day of surgery, antibiotic concentrations were measured in the blood and at seven prespecified biopsy sites within each cavity. Mycobacterium tuberculosis was grown from each biopsy site, MICs of each drug identified, and whole-genome sequencing performed. Spearman correlation coefficients between drug concentration and MIC were calculated. MEASUREMENTS AND MAIN RESULTS Fourteen patients treated for a median of 13 months (range, 5-31 mo) were recruited. MICs and drug resistance-associated single-nucleotide variants differed between the different geospatial locations within each cavity, and with pretreatment and serial sputum isolates, consistent with ongoing acquisition of resistance. However, pretreatment sputum MIC had an accuracy of only 49.48% in predicting cavitary MICs. There were large concentration-distance gradients for each antibiotic. The location-specific concentrations inversely correlated with MICs (P < 0.05) and therefore acquired resistance. Moreover, pharmacokinetic/pharmacodynamic exposures known to amplify drug-resistant subpopulations were encountered in all positions. CONCLUSIONS These data inform interventional strategies relevant to drug delivery, dosing, and diagnostics to prevent the development of acquired resistance. The role of high intracavitary penetration as a biomarker of antibiotic efficacy, when assessing new regimens, requires clarification.
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Affiliation(s)
- Keertan Dheda
- 1 Center for Lung Infection and Immunity, Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine.,2 Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Laura Lenders
- 1 Center for Lung Infection and Immunity, Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine
| | - Gesham Magombedze
- 3 Center for Infectious Diseases Research and Experimental Therapeutics and
| | | | - Prithvi Raj
- 4 Department of Immunology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Erland Arning
- 5 Institute of Metabolic Disease, Baylor Research Institute, Baylor University Medical Center, Dallas, Texas
| | - Paula Ashcraft
- 5 Institute of Metabolic Disease, Baylor Research Institute, Baylor University Medical Center, Dallas, Texas
| | - Teodoro Bottiglieri
- 5 Institute of Metabolic Disease, Baylor Research Institute, Baylor University Medical Center, Dallas, Texas
| | | | - Timothy Pennel
- 7 Chris Barnard Division of Cardiothoracic Surgery, Department of Surgery, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Anthony Linegar
- 7 Chris Barnard Division of Cardiothoracic Surgery, Department of Surgery, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Loven Moodley
- 7 Chris Barnard Division of Cardiothoracic Surgery, Department of Surgery, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Anil Pooran
- 1 Center for Lung Infection and Immunity, Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine
| | | | - Frederick A Sirgel
- 8 Division of Molecular Biology and Human Genetics, South African Medical Research Council Centre for Tuberculosis Research/Department of Science and Technology/National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research, Stellenbosch University, Stellenbosch, South Africa
| | - Paul D van Helden
- 8 Division of Molecular Biology and Human Genetics, South African Medical Research Council Centre for Tuberculosis Research/Department of Science and Technology/National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research, Stellenbosch University, Stellenbosch, South Africa
| | - Edward Wakeland
- 4 Department of Immunology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Robin M Warren
- 8 Division of Molecular Biology and Human Genetics, South African Medical Research Council Centre for Tuberculosis Research/Department of Science and Technology/National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research, Stellenbosch University, Stellenbosch, South Africa
| | - Tawanda Gumbo
- 1 Center for Lung Infection and Immunity, Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine.,3 Center for Infectious Diseases Research and Experimental Therapeutics and
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35
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Savioli MTG, Morrone N, Santoro I. Primary bacillary resistance in multidrug-resistant tuberculosis and predictive factors associated with cure at a referral center in São Paulo, Brazil. J Bras Pneumol 2019; 45:e20180075. [PMID: 30864608 PMCID: PMC6733733 DOI: 10.1590/1806-3713/e20180075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 08/12/2018] [Indexed: 11/30/2022] Open
Abstract
Objective: To identify transmitted or primary resistance among cases of multidrug-resistant tuberculosis and predictive factors for cure in multidrug-resistant tuberculosis after the first treatment. Method: Descriptive study of a cohort from 2006 to 2010, in a reference unit of tuberculosis in São Paulo, Brazil. The data were obtained by the revision of medical records. Clinical criteria were used to classify transmitted and acquired resistance. Extended primary resistance was also defined, in this study, as cases initially treated with a standardized scheme, but with no therapeutic success, and the pre-treatment drug susceptibility test (DST) showed presence of resistance. Results: 156 patients with multidrug-resistant tuberculosis and their respective sputum samples were eligible for the study. Only 7% of the patients were positive for the human immunodeficiency virus (HIV). Previous treatment occurred in 95% of the sample. The cure rate after the first treatment was 54%. The median bacteriological conversion time of those who healed was one month. Bacillary resistance was considered acquired resistance in 100 (64%) and transmitted resistance in 56 (36%). By logistic regression, patients who presented primary multidrug-resistant tuberculosis (odds ratio-OR = 6,29), without comorbidity (OR = 3,37) and with higher initial weight (OR = 1.04) were associated with cure after the first treatment. Conclusion: The early detection of bacillary resistance and appropriate treatment are in favor of healing. Thus, it is crucial to know exactly the primary resistance rate avoiding the use of inadequate treatments, amplification of bacillary resistance and its transmission.
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Affiliation(s)
| | - Nelson Morrone
- . Hospital do Servidor Público Municipal, São Paulo (SP) Brasil
| | - Ilka Santoro
- . Universidade Federal de São Paulo, São Paulo (SP) Brasil
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36
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Heinrichs MT, Vashakidze S, Nikolaishvili K, Sabulua I, Tukvadze N, Bablishvili N, Gogishvili S, Little BP, Bernheim A, Guarner J, Peloquin CA, Blumberg HM, Derendorf H, Kempker RR. Moxifloxacin target site concentrations in patients with pulmonary TB utilizing microdialysis: a clinical pharmacokinetic study. J Antimicrob Chemother 2019; 73:477-483. [PMID: 29186509 DOI: 10.1093/jac/dkx421] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 10/17/2017] [Indexed: 11/14/2022] Open
Abstract
Background Moxifloxacin is a second-line anti-TB drug that is useful in the treatment of drug-resistant TB. However, little is known about its target site pharmacokinetics. Lower drug concentrations at the infection site (i.e. in severe lung lesions including cavitary lesions) may lead to development and amplification of drug resistance. Improved knowledge regarding tissue penetration of anti-TB drugs will help guide drug development and optimize drug dosing. Methods Patients with culture-confirmed drug-resistant pulmonary TB scheduled to undergo adjunctive surgical lung resection were enrolled in Tbilisi, Georgia. Five serum samples per patient were collected at different timepoints including at the time of surgical resection (approximately at Tmax). Microdialysis was performed in the ex vivo tissue immediately after resection. Non-compartmental analysis was performed and a tissue/serum concentration ratio was calculated. Results Among the seven patients enrolled, the median moxifloxacin dose given was 7.7 mg/kg, the median age was 25.2 years, 57% were male and the median creatinine clearance was 95.4 mL/min. Most patients (71%) had suboptimal steady-state serum Cmax (total drug) concentrations. The median free moxifloxacin serum concentration at time of surgical resection was 1.23 μg/mL (range = 0.12-1.80) and the median free lung tissue concentration was 3.37 μg/mL (range = 0.81-5.76). The median free-tissue/free-serum concentration ratio was 3.20 (range = 0.66-28.08). Conclusions Moxifloxacin showed excellent penetration into diseased lung tissue (including cavitary lesions) among patients with pulmonary TB. Moxifloxacin lung tissue concentrations were higher than those seen in serum. Our findings highlight the importance of moxifloxacin in the treatment of MDR-TB and potentially any patient with pulmonary TB and severe lung lesions.
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Affiliation(s)
| | - Sergo Vashakidze
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
| | | | - Irina Sabulua
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
| | - Nestani Tukvadze
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
| | - Nino Bablishvili
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
| | - Shota Gogishvili
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
| | - Brent P Little
- Department of Radiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Adam Bernheim
- Department of Radiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Jeannette Guarner
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Henry M Blumberg
- Division of Infectious Diseases Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.,Departments of Epidemiology and Global Health, Emory Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Russell R Kempker
- Division of Infectious Diseases Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
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37
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Loutet MG, Davidson JA, Brown T, Dedicoat M, Thomas HL, Lalor MK. Acquired Resistance to Antituberculosis Drugs in England, Wales, and Northern Ireland, 2000-2015. Emerg Infect Dis 2019; 24:524-533. [PMID: 29460735 PMCID: PMC5823342 DOI: 10.3201/eid2403.171362] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Among tuberculosis (TB) patients, acquired resistance to anti-TB drugs represents a failure in the treatment pathway. To improve diagnosis and care for patients with drug-resistant TB, we examined the epidemiology and risk factors associated with acquired drug resistance during 2000–2015 among TB patients in England, Wales, and Northern Ireland. We found acquired resistance in 0.2% (158/67,710) of patients with culture-confirmed TB. Using multivariate logistic regression, we identified the following factors associated with acquired drug resistance: having pulmonary disease; initial resistance to isoniazid, rifampin, or both; a previous TB episode; and being born in China or South Africa. Treatment outcomes were worse for patients with than without acquired resistance. Although acquired resistance is rare in the study area, certain patient groups are at higher risk. Identifying these patients and ensuring that adequate resources are available for treatment may prevent acquisition of resistance, thereby limiting transmission of drug-resistant strains of mycobacteria.
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38
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Deshpande D, Pasipanodya JG, Mpagama SG, Bendet P, Srivastava S, Koeuth T, Lee PS, Bhavnani SM, Ambrose PG, Thwaites G, Heysell SK, Gumbo T. Levofloxacin Pharmacokinetics/Pharmacodynamics, Dosing, Susceptibility Breakpoints, and Artificial Intelligence in the Treatment of Multidrug-resistant Tuberculosis. Clin Infect Dis 2018; 67:S293-S302. [PMID: 30496461 PMCID: PMC6260169 DOI: 10.1093/cid/ciy611] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background Levofloxacin is used for the treatment of multidrug-resistant tuberculosis; however the optimal dose is unknown. Methods We used the hollow fiber system model of tuberculosis (HFS-TB) to identify 0-24 hour area under the concentration-time curve (AUC0-24) to minimum inhibitory concentration (MIC) ratios associated with maximal microbial kill and suppression of acquired drug resistance (ADR) of Mycobacterium tuberculosis (Mtb). Levofloxacin-resistant isolates underwent whole-genome sequencing. Ten thousands patient Monte Carlo experiments (MCEs) were used to identify doses best able to achieve the HFS-TB-derived target exposures in cavitary tuberculosis and tuberculous meningitis. Next, we used an ensemble of artificial intelligence (AI) algorithms to identify the most important predictors of sputum conversion, ADR, and death in Tanzanian patients with pulmonary multidrug-resistant tuberculosis treated with a levofloxacin-containing regimen. We also performed probit regression to identify optimal levofloxacin doses in Vietnamese tuberculous meningitis patients. Results In the HFS-TB, the AUC0-24/MIC associated with maximal Mtb kill was 146, while that associated with suppression of resistance was 360. The most common gyrA mutations in resistant Mtb were Asp94Gly, Asp94Asn, and Asp94Tyr. The minimum dose to achieve target exposures in MCEs was 1500 mg/day. AI algorithms identified an AUC0-24/MIC of 160 as predictive of microbiologic cure, followed by levofloxacin 2-hour peak concentration and body weight. Probit regression identified an optimal dose of 25 mg/kg as associated with >90% favorable response in adults with pulmonary tuberculosis. Conclusions The levofloxacin dose of 25 mg/kg or 1500 mg/day was adequate for replacement of high-dose moxifloxacin in treatment of multidrug-resistant tuberculosis.
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Affiliation(s)
- Devyani Deshpande
- Center for Infectious Diseases Research and Experimental Therapeutics, Baylor Research Institute, Baylor University Medical Center, Dallas, Texas
| | - Jotam G Pasipanodya
- Center for Infectious Diseases Research and Experimental Therapeutics, Baylor Research Institute, Baylor University Medical Center, Dallas, Texas
| | | | - Paula Bendet
- Center for Infectious Diseases Research and Experimental Therapeutics, Baylor Research Institute, Baylor University Medical Center, Dallas, Texas
| | - Shashikant Srivastava
- Center for Infectious Diseases Research and Experimental Therapeutics, Baylor Research Institute, Baylor University Medical Center, Dallas, Texas
| | - Thearith Koeuth
- Center for Infectious Diseases Research and Experimental Therapeutics, Baylor Research Institute, Baylor University Medical Center, Dallas, Texas
| | - Pooi S Lee
- Center for Infectious Diseases Research and Experimental Therapeutics, Baylor Research Institute, Baylor University Medical Center, Dallas, Texas
| | | | - Paul G Ambrose
- Institute for Clinical Pharmacodynamics, Schenectady, New York
| | - Guy Thwaites
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, Churchill Hospital, Oxford, United Kingdom
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Scott K Heysell
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville
| | - Tawanda Gumbo
- Center for Infectious Diseases Research and Experimental Therapeutics, Baylor Research Institute, Baylor University Medical Center, Dallas, Texas
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Graciaa DS, Machaidze M, Kipiani M, Buziashvili M, Barbakadze K, Avaliani Z, Kempker RR. A survey of the tuberculosis physician workforce in the country of Georgia. Int J Tuberc Lung Dis 2018; 22:1286-1292. [PMID: 30355407 PMCID: PMC6282195 DOI: 10.5588/ijtld.18.0085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING A well-trained and sufficient tuberculosis (TB) workforce is essential for disease control, especially in an era of newly implemented diagnostics and medications. However, there are few reports on the status of the TB workforce in many endemic countries. OBJECTIVE To evaluate the demographics, salary, career satisfaction, and attitudes towards the field of TB among the physician TB workforce in the country of Georgia. DESIGN A cross-sectional study of physicians in the current Georgian National TB Programme (NTP) using an anonymous 31-item questionnaire. RESULTS Among 184 NTP physicians countrywide, 142 (77%) were contacted and 138 (75%) completed questionnaires. The median age was 56 years (interquartile range 50-64); most (81%) were female. The monthly salary from TB work was USD205 for 50% of respondents. Nearly half (47%) received an additional salary from another source. Many physicians (65%) indicated that they were satisfied with their work, but over half (55%) were unsatisfied with reimbursement. While most physicians (78%) were concerned about the lack of interest in TB, only 36% would recommend a career in TB care. CONCLUSION While the current TB workforce in Georgia finds their work fulfilling, an ageing workforce, low salaries and perceived lack of interest in the field are a matter of concern for future TB control.
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Affiliation(s)
- D S Graciaa
- Department of Medicine and Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - M Machaidze
- Division of Infectious Diseases, New York University School of Medicine, New York, New York, USA
| | - M Kipiani
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
| | - M Buziashvili
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
| | - K Barbakadze
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
| | - Z Avaliani
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
| | - R R Kempker
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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Nguyen QH, Contamin L, Nguyen TVA, Bañuls A. Insights into the processes that drive the evolution of drug resistance in Mycobacterium tuberculosis. Evol Appl 2018; 11:1498-1511. [PMID: 30344622 PMCID: PMC6183457 DOI: 10.1111/eva.12654] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 05/25/2018] [Accepted: 05/27/2018] [Indexed: 01/01/2023] Open
Abstract
At present, the successful transmission of drug-resistant Mycobacterium tuberculosis, including multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains, in human populations, threatens tuberculosis control worldwide. Differently from many other bacteria, M. tuberculosis drug resistance is acquired mainly through mutations in specific drug resistance-associated genes. The panel of mutations is highly diverse, but depends on the affected gene and M. tuberculosis genetic background. The variety of genetic profiles observed in drug-resistant clinical isolates underlines different evolutionary trajectories towards multiple drug resistance, although some mutation patterns are prominent. This review discusses the intrinsic processes that may influence drug resistance evolution in M. tuberculosis, such as mutation rate, drug resistance-associated mutations, fitness cost, compensatory mutations and epistasis. This knowledge should help to better predict the risk of emergence of highly resistant M. tuberculosis strains and to develop new tools and strategies to limit the development and spread of MDR and XDR strains.
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Affiliation(s)
- Quang Huy Nguyen
- Department of Pharmacological, Medical and Agronomical BiotechnologyUniversity of Science and Technology of HanoiVietnam Academy of Science and Technology (VAST)HanoiVietnam
- Institute of Research for DevelopmentUMR MIVEGEC (CNRS‐IRD‐University of Montpellier)MontpellierFrance
- LMI Drug Resistance in South East Asia (LMI DRISA)University of Science and Technology of HanoiVietnam Academy of Science and Technology (VAST)HanoiVietnam
| | - Lucie Contamin
- Institute of Research for DevelopmentUMR MIVEGEC (CNRS‐IRD‐University of Montpellier)MontpellierFrance
- LMI Drug Resistance in South East Asia (LMI DRISA)University of Science and Technology of HanoiVietnam Academy of Science and Technology (VAST)HanoiVietnam
- Department of BacteriologyNational Institute of Hygiene and Epidemiology (NIHE)HanoiVietnam
| | - Thi Van Anh Nguyen
- Department of BacteriologyNational Institute of Hygiene and Epidemiology (NIHE)HanoiVietnam
| | - Anne‐Laure Bañuls
- Institute of Research for DevelopmentUMR MIVEGEC (CNRS‐IRD‐University of Montpellier)MontpellierFrance
- LMI Drug Resistance in South East Asia (LMI DRISA)University of Science and Technology of HanoiVietnam Academy of Science and Technology (VAST)HanoiVietnam
- Department of BacteriologyNational Institute of Hygiene and Epidemiology (NIHE)HanoiVietnam
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Ahmad N, Ahuja SD, Akkerman OW, Alffenaar JWC, Anderson LF, Baghaei P, Bang D, Barry PM, Bastos ML, Behera D, Benedetti A, Bisson GP, Boeree MJ, Bonnet M, Brode SK, Brust JCM, Cai Y, Caumes E, Cegielski JP, Centis R, Chan PC, Chan ED, Chang KC, Charles M, Cirule A, Dalcolmo MP, D'Ambrosio L, de Vries G, Dheda K, Esmail A, Flood J, Fox GJ, Fréchet-Jachym M, Fregona G, Gayoso R, Gegia M, Gler MT, Gu S, Guglielmetti L, Holtz TH, Hughes J, Isaakidis P, Jarlsberg L, Kempker RR, Keshavjee S, Khan FA, Kipiani M, Koenig SP, Koh WJ, Kritski A, Kuksa L, Kvasnovsky CL, Kwak N, Lan Z, Lange C, Laniado-Laborín R, Lee M, Leimane V, Leung CC, Leung ECC, Li PZ, Lowenthal P, Maciel EL, Marks SM, Mase S, Mbuagbaw L, Migliori GB, Milanov V, Miller AC, Mitnick CD, Modongo C, Mohr E, Monedero I, Nahid P, Ndjeka N, O'Donnell MR, Padayatchi N, Palmero D, Pape JW, Podewils LJ, Reynolds I, Riekstina V, Robert J, Rodriguez M, Seaworth B, Seung KJ, Schnippel K, Shim TS, Singla R, Smith SE, Sotgiu G, Sukhbaatar G, Tabarsi P, Tiberi S, Trajman A, Trieu L, Udwadia ZF, van der Werf TS, Veziris N, Viiklepp P, Vilbrun SC, Walsh K, Westenhouse J, Yew WW, Yim JJ, Zetola NM, Zignol M, Menzies D. Treatment correlates of successful outcomes in pulmonary multidrug-resistant tuberculosis: an individual patient data meta-analysis. Lancet 2018; 392:821-834. [PMID: 30215381 PMCID: PMC6463280 DOI: 10.1016/s0140-6736(18)31644-1] [Citation(s) in RCA: 384] [Impact Index Per Article: 64.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 07/12/2018] [Accepted: 07/13/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Treatment outcomes for multidrug-resistant tuberculosis remain poor. We aimed to estimate the association of treatment success and death with the use of individual drugs, and the optimal number and duration of treatment with those drugs in patients with multidrug-resistant tuberculosis. METHODS In this individual patient data meta-analysis, we searched MEDLINE, Embase, and the Cochrane Library to identify potentially eligible observational and experimental studies published between Jan 1, 2009, and April 30, 2016. We also searched reference lists from all systematic reviews of treatment of multidrug-resistant tuberculosis published since 2009. To be eligible, studies had to report original results, with end of treatment outcomes (treatment completion [success], failure, or relapse) in cohorts of at least 25 adults (aged >18 years). We used anonymised individual patient data from eligible studies, provided by study investigators, regarding clinical characteristics, treatment, and outcomes. Using propensity score-matched generalised mixed effects logistic, or linear regression, we calculated adjusted odds ratios and adjusted risk differences for success or death during treatment, for specific drugs currently used to treat multidrug-resistant tuberculosis, as well as the number of drugs used and treatment duration. FINDINGS Of 12 030 patients from 25 countries in 50 studies, 7346 (61%) had treatment success, 1017 (8%) had failure or relapse, and 1729 (14%) died. Compared with failure or relapse, treatment success was positively associated with the use of linezolid (adjusted risk difference 0·15, 95% CI 0·11 to 0·18), levofloxacin (0·15, 0·13 to 0·18), carbapenems (0·14, 0·06 to 0·21), moxifloxacin (0·11, 0·08 to 0·14), bedaquiline (0·10, 0·05 to 0·14), and clofazimine (0·06, 0·01 to 0·10). There was a significant association between reduced mortality and use of linezolid (-0·20, -0·23 to -0·16), levofloxacin (-0·06, -0·09 to -0·04), moxifloxacin (-0·07, -0·10 to -0·04), or bedaquiline (-0·14, -0·19 to -0·10). Compared with regimens without any injectable drug, amikacin provided modest benefits, but kanamycin and capreomycin were associated with worse outcomes. The remaining drugs were associated with slight or no improvements in outcomes. Treatment outcomes were significantly worse for most drugs if they were used despite in-vitro resistance. The optimal number of effective drugs seemed to be five in the initial phase, and four in the continuation phase. In these adjusted analyses, heterogeneity, based on a simulated I2 method, was high for approximately half the estimates for specific drugs, although relatively low for number of drugs and durations analyses. INTERPRETATION Although inferences are limited by the observational nature of these data, treatment outcomes were significantly better with use of linezolid, later generation fluoroquinolones, bedaquiline, clofazimine, and carbapenems for treatment of multidrug-resistant tuberculosis. These findings emphasise the need for trials to ascertain the optimal combination and duration of these drugs for treatment of this condition. FUNDING American Thoracic Society, Canadian Institutes of Health Research, US Centers for Disease Control and Prevention, European Respiratory Society, Infectious Diseases Society of America.
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Affiliation(s)
- Nafees Ahmad
- Faculty of Pharmacy and Health Sciences, University of Baluchistan, Quetta, Pakistan
| | - Shama D Ahuja
- Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, NY, USA
| | - Onno W Akkerman
- Department of Pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands; Tuberculosis Centre Beatrixoord, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
| | - Jan-Willem C Alffenaar
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
| | - Laura F Anderson
- Global Tuberculosis Program, World Health Organization, Geneva, Switzerland
| | - Parvaneh Baghaei
- Clinical Tuberculosis and Epidemiology Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Didi Bang
- Statens Serum Institut, Copenhagen, Denmark
| | - Pennan M Barry
- Tuberculosis Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, CA, USA
| | - Mayara L Bastos
- Social Medicine Institute, Epidemiology Department, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Digamber Behera
- Department of Pulmonary Medicine, World Health Organization Collaborating Centre for Research & Capacity Building in Chronic Respiratory Diseases, Chandigarh, India; Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Andrea Benedetti
- Montreal Chest Institute, McGill University Health Center Research Institute, McGill University, Montreal, QC, Canada
| | - Gregory P Bisson
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Martin J Boeree
- Department of Pulmonary Diseases, Radboud University Medicale Centre Nijmegen and Dekkerswald Radboudumc Groesbeek, Netherlands
| | - Maryline Bonnet
- Epicentre MSF, Paris, France; Institut de Recherche pour le Développement UM233, INSERM U1175, Université de Montpellier, Montpellier, France
| | - Sarah K Brode
- Department of Medicine, Division of Respirology, University of Toronto, West Park Healthcare Centre, University Health Network, and Sinai Health System, Toronto, ON, Canada
| | - James C M Brust
- Division of General Internal Medicine and Division of Infectious Diseases, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA
| | - Ying Cai
- Tuberculosis Research Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, US National Institutes of Health, Bethesda, MD, USA
| | - Eric Caumes
- AP-HP, Service des Maladies Infectieuses et Tropicales, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Paris, France
| | - J Peter Cegielski
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rosella Centis
- World Health Organization Collaborating Centre for Tuberculosis and Lung Diseases, Maugeri Care and Research Institute, Tradate, Italy
| | - Pei-Chun Chan
- Division of Chronic Infectious Diseases, Taiwan Centers for Disease Control, Taipei, Taiwan
| | - Edward D Chan
- Department of Medicine, University of Colorado Denver, Aurora, CO, USA; Department of Medicine, National Jewish Health, Denver, CO, USA; VA Medical Center, Denver, CO, USA
| | - Kwok-Chiu Chang
- Department of Health, Tuberculosis and Chest Service, Centre for Health Protection, Hong Kong Special Administrative Region, China
| | - Macarthur Charles
- Centers for Disease Control and Prevention, Haiti Country Office, Port-au-Prince, Haiti
| | - Andra Cirule
- Centre of TB and Lung Diseases, Riga East University Hospital, Riga, Latvia
| | | | - Lia D'Ambrosio
- World Health Organization Collaborating Centre for Tuberculosis and Lung Diseases, Maugeri Care and Research Institute, Tradate, Italy; Public Health Consulting Group, Lugano, Switzerland
| | - Gerard de Vries
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands; KNCV Tuberculosis Foundation, The Hague, Netherlands
| | - Keertan Dheda
- Centre for Lung Infection and Immunity, Department of Medicine & UCT Lung Institute, University of Cape Town, Cape Town, South Africa
| | - Aliasgar Esmail
- Centre for Lung Infection and Immunity, Department of Medicine & UCT Lung Institute, University of Cape Town, Cape Town, South Africa
| | - Jennifer Flood
- Tuberculosis Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, CA, USA
| | - Gregory J Fox
- Sydney Medical School, University of Sydney, NSW, Australia
| | | | - Geisa Fregona
- University Federal of Espirito Santo, Vitória, Brazil
| | | | - Medea Gegia
- Global Tuberculosis Program, World Health Organization, Geneva, Switzerland
| | | | - Sue Gu
- Department of Medicine, University of Colorado Denver, Aurora, CO, USA
| | - Lorenzo Guglielmetti
- AP-HP, Laboratoire de Bactériologie-Hygiène, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Paris, France; Sorbonne Université, Centre d'Immunologie et des Maladies Infectieuses (CIMI; INSERM U1135/UMRS CR7/CNRS ERL 8255), Bactériologie, Faculté de Médecine Sorbonne Université, Paris, France; Sanatorium, Centre Hospitalier de Bligny, Briis-sous-Forges, France
| | - Timothy H Holtz
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Leah Jarlsberg
- Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, CA, USA
| | - Russell R Kempker
- Emory University School of Medicine, Division of Infectious Diseases, Atlanta, GA, USA
| | - Salmaan Keshavjee
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | - Faiz Ahmad Khan
- Montreal Chest Institute, McGill University Health Center Research Institute, McGill University, Montreal, QC, Canada
| | - Maia Kipiani
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
| | - Serena P Koenig
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA; Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Won-Jung Koh
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Afranio Kritski
- Academic Tuberculosis Program, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Liga Kuksa
- Department of MDR TB, Riga East University Hospital, Riga, Latvia
| | - Charlotte L Kvasnovsky
- Division of Pediatric Surgery, Cohen Children's Medical Center, Hofstra Northwell School of Medicine, New Hyde Park, NY, USA
| | - Nakwon Kwak
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Zhiyi Lan
- Montreal Chest Institute, McGill University Health Center Research Institute, McGill University, Montreal, QC, Canada
| | - Christoph Lange
- Division of Clinical Infectious Diseases, Research Center Borstel, Germany; German Center for Infection Research, Clinical Tuberculosis Unit, Borstel, Germany; International Health/Infectious Diseases, University of Luebeck, Luebeck, Germany; Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | | | - Myungsun Lee
- Clinical Research Section, International Tuberculosis Research Centre, Seoul, South Korea
| | - Vaira Leimane
- Centre of TB and Lung Diseases, Riga East University Hospital, Riga, Latvia
| | - Chi-Chiu Leung
- Department of Health, Tuberculosis and Chest Service, Centre for Health Protection, Hong Kong Special Administrative Region, China
| | - Eric Chung-Ching Leung
- Department of Health, Tuberculosis and Chest Service, Centre for Health Protection, Hong Kong Special Administrative Region, China
| | - Pei Zhi Li
- Montreal Chest Institute, McGill University Health Center Research Institute, McGill University, Montreal, QC, Canada
| | - Phil Lowenthal
- Tuberculosis Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, CA, USA
| | | | - Suzanne M Marks
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sundari Mase
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA, USA; Regional WHO Office, New Delhi, India
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada; Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Giovanni B Migliori
- World Health Organization Collaborating Centre for Tuberculosis and Lung Diseases, Maugeri Care and Research Institute, Tradate, Italy
| | - Vladimir Milanov
- Medical Faculty, Medical University-Sofia, University Hospital for Respiratory Diseases "St. Sofia", Sofia, Bulgaria
| | - Ann C Miller
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Carole D Mitnick
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | | | - Erika Mohr
- Médecins Sans Frontières, Khayelitsha, South Africa
| | - Ignacio Monedero
- TB-HIV Department, International Union against Tuberculosis and Lung Diseases, Paris, France
| | - Payam Nahid
- Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, CA, USA
| | - Norbert Ndjeka
- National TB Programme, South African National Department of Health, Pretoria, South Africa
| | - Max R O'Donnell
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Nesri Padayatchi
- CAPRISA, MRC TB-HIV Treatment and Pathogenesis Research Unit, Durban, South Africa
| | - Domingo Palmero
- Pulmonology Division, Municipal Hospital F J Munĩz, Buenos Aires, Argentina
| | - Jean William Pape
- Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti; Center for Global Health, Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Laura J Podewils
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ian Reynolds
- Department of Medicine, University of Colorado Denver, Aurora, CO, USA
| | - Vija Riekstina
- Centre of TB and Lung Diseases, Riga East University Hospital, Riga, Latvia
| | - Jérôme Robert
- AP-HP, Laboratoire de Bactériologie-Hygiène, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Paris, France; Sorbonne Université, Centre d'Immunologie et des Maladies Infectieuses (CIMI; INSERM U1135/UMRS CR7/CNRS ERL 8255), Bactériologie, Faculté de Médecine Sorbonne Université, Paris, France
| | | | - Barbara Seaworth
- Heartland National TB Center, University of Texas Health Science Center at Tyler, Tyler, TX, USA
| | | | - Kathryn Schnippel
- Faculty of Health Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Tae Sun Shim
- Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Seoul, South Korea
| | - Rupak Singla
- National Institute of Tuberculosis & Respiratory Diseases, New Delhi, India
| | - Sarah E Smith
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Giovanni Sotgiu
- Department of Medical, Surgical and Experimental Sciences, Clinical Epidemiology and Medical Statistics Unit, University of Sassari, Sassari, Italy
| | | | - Payam Tabarsi
- Clinical Tuberculosis and Epidemiology Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Simon Tiberi
- Royal London Hospital, Barts Health NHS Trust, London, UK; Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Anete Trajman
- Social Medicine Institute, Epidemiology Department, State University of Rio de Janeiro, Rio de Janeiro, Brazil; Montreal Chest Institute, McGill University Health Center Research Institute, McGill University, Montreal, QC, Canada; Academic Tuberculosis Program, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lisa Trieu
- Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, NY, USA
| | | | - Tjip S van der Werf
- Department of Pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands; Department of Internal Medicine/Infectious Diseases, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
| | - Nicolas Veziris
- AP-HP, Laboratoire de Bactériologie-Hygiène, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Paris, France; Sorbonne Université, Centre d'Immunologie et des Maladies Infectieuses (CIMI; INSERM U1135/UMRS CR7/CNRS ERL 8255), Bactériologie, Faculté de Médecine Sorbonne Université, Paris, France
| | - Piret Viiklepp
- Estonian Tuberculosis Registry, National Institute for Health Development, Tallinn, Estonia
| | - Stalz Charles Vilbrun
- Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Kathleen Walsh
- Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Janice Westenhouse
- Tuberculosis Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, CA, USA
| | - Wing-Wai Yew
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Jae-Joon Yim
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | | | - Matteo Zignol
- Global Tuberculosis Program, World Health Organization, Geneva, Switzerland
| | - Dick Menzies
- Montreal Chest Institute, McGill University Health Center Research Institute, McGill University, Montreal, QC, Canada.
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Comorbidities and treatment outcomes in multidrug resistant tuberculosis: a systematic review and meta-analysis. Sci Rep 2018; 8:4980. [PMID: 29563561 PMCID: PMC5862834 DOI: 10.1038/s41598-018-23344-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 03/09/2018] [Indexed: 01/14/2023] Open
Abstract
Little is known about the impact of comorbidities on multidrug resistant (MDR) and extensively drug resistant (XDR) tuberculosis (TB) treatment outcomes. We aimed to examine the effect of human immunodeficiency virus (HIV), diabetes, chronic kidney disease (CKD), alcohol misuse, and smoking on MDR/XDRTB treatment outcomes. We searched MEDLINE, EMBASE, Cochrane Central Registrar and Cochrane Database of Systematic Reviews as per PRISMA guidelines. Eligible studies were identified and treatment outcome data were extracted. We performed a meta-analysis to generate a pooled relative risk (RR) for unsuccessful outcome in MDR/XDRTB treatment by co-morbidity. From 2457 studies identified, 48 reported on 18,257 participants, which were included in the final analysis. Median study population was 235 (range 60-1768). Pooled RR of unsuccessful outcome was higher in people living with HIV (RR = 1.41 [95%CI: 1.15-1.73]) and in people with alcohol misuse (RR = 1.45 [95%CI: 1.21-1.74]). Outcomes were similar in people with diabetes or in people that smoked. Data was insufficient to examine outcomes in exclusive XDRTB or CKD cohorts. In this systematic review and meta-analysis, alcohol misuse and HIV were associated with higher pooled OR of an unsuccessful outcome in MDR/XDRTB treatment. Further research is required to understand the role of comorbidities in driving unsuccessful treatment outcomes.
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Nellums LB, Rustage K, Hargreaves S, Friedland JS. Multidrug-resistant tuberculosis treatment adherence in migrants: a systematic review and meta-analysis. BMC Med 2018; 16:27. [PMID: 29466983 PMCID: PMC5822608 DOI: 10.1186/s12916-017-1001-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 12/21/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multidrug-resistant tuberculosis (MDR-TB) is a growing concern in meeting global targets for TB control. In high-income low-TB-incidence countries, a disproportionate number of MDR-TB cases occur in migrant (foreign-born) populations, with concerns about low adherence rates in these patients compared to the host non-migrant population. Tackling MDR-TB in this context may, therefore, require unique approaches. We conducted a systematic review and meta-analysis to identify and synthesise data on MDR-TB treatment adherence in migrant patients to inform evidence-based strategies to improve care pathways and health outcomes in this group. METHODS This systematic review and meta-analysis was conducted in line with PRISMA guidelines (PROSPERO 42017070756). The databases Embase, MEDLINE, Global Health and PubMed were searched to 24 May 2017 for primary research reporting MDR-TB treatment adherence and outcomes in migrant populations, with no restrictions on dates or language. A meta-analysis was conducted using random-effects models. RESULTS From 413 papers identified in the database search, 15 studies reporting on MDR-TB treatment outcomes for 258 migrants and 174 non-migrants were included in the systematic review and meta-analysis. The estimated rate of adherence to MDR-TB treatment across migrant patients was 71% [95% confidence interval (CI) = 58-84%], with non-adherence reported among 20% (95% CI = 4-37%) of migrant patients. A key finding was that there were no differences in estimated rates of adherence [risk ratio (RR) = 1.05; 95% CI = 0.82-1.34] or non-adherence (RR = 0.97; 95% CI = 0.79-1.36) between migrants and non-migrants. CONCLUSIONS MDR-TB treatment adherence rates among migrants in high-income low-TB-incidence countries are approaching global targets for treatment success (75%), and are comparable to rates in non-migrants. The findings highlight that only just over 70% of migrant and non-migrant patients adhere to MDR-TB treatment. The results point to the importance of increasing adherence in all patient groups, including migrants, with an emphasis on tailoring care based on social risk factors for poor adherence. We believe that MDR-TB treatment targets are not ambitious enough.
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Affiliation(s)
- Laura B. Nellums
- Infectious Diseases & Immunity, Department of Medicine, Imperial College London, Hammersmith Hospital, Du Cane Road, London, W12 ONN UK
| | - Kieran Rustage
- Infectious Diseases & Immunity, Department of Medicine, Imperial College London, Hammersmith Hospital, Du Cane Road, London, W12 ONN UK
| | - Sally Hargreaves
- Infectious Diseases & Immunity, Department of Medicine, Imperial College London, Hammersmith Hospital, Du Cane Road, London, W12 ONN UK
| | - Jon S. Friedland
- Infectious Diseases & Immunity, Department of Medicine, Imperial College London, Hammersmith Hospital, Du Cane Road, London, W12 ONN UK
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Getnet F, Sileshi H, Seifu W, Yirga S, Alemu AS. Do retreatment tuberculosis patients need special treatment response follow-up beyond the standard regimen? Finding of five-year retrospective study in pastoralist setting. BMC Infect Dis 2017; 17:762. [PMID: 29233121 PMCID: PMC5727921 DOI: 10.1186/s12879-017-2882-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 12/04/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Treatment outcomes serve as proxy measures of the quality of tuberculosis treatment provided by the health care system, and it is essential to evaluate the effectiveness of Directly Observed Therapy-Short course program in controlling the disease, and reducing treatment failure, default and death. Hence, we evaluated tuberculosis treatment success rate, its trends and predictors of unsuccessful treatment outcome in Ethiopian Somali region where 85% of its population is pastoralist. METHODS A retrospective review of 5 years data (September 2009 to August 2014) was conducted to evaluate the treatment outcome of 1378 randomly selected tuberculosis patients treated in Kharamara, Dege-habour and Gode hospitals. We extracted data on socio-demographics, HIV Sero-status, tuberculosis type, treatment outcome and year using clinical chart abstraction sheet. Tuberculosis treatment outcomes were categorized into successful (cured and/or completed) and unsuccessful (died/failed/default) according to the national tuberculosis guideline. Data was entered using EpiData 3.1 and analyzed using SPSS 20. Chi-square (χ2) test and logistic regression model were used to reveal the predictors of unsuccessful treatment outcome at P ≤ 0.05 significance level. RESULT The majority of participants was male (59.1%), pulmonary smear negative (49.2%) and new cases (90.6%). The median age was 26 years [IQR: 18-40] and HIV co-infection rate was 4.6%. The overall treatment success rate was 86.8% [95%CI: 84.9% - 88.5%]; however, 4.8%, 7.6% and 0.7% of patients died, defaulted and failed to cure respectively. It fluctuated across the years and ranged from 76.9% to 94% [p < 0.001]. The odds of death/failure [AOR = 2.4; 95%CI = 1.4-3.9] and pulmonary smear positivity [AOR = 2.3; 95%CI = 1.6-3.5] were considerably higher among retreatment patients compared to new counterparts. Unsuccessful treatment outcome was significantly higher in less urbanized hospitals [p < 0.001]. Treatment success rate had insignificant difference between age groups, genders, tuberculosis types and HIV status (P > 0.05). CONCLUSION This study revealed that the overall tuberculosis treatment success rate has realized the global target for 2011-2015. However, it does not guarantee its continuity as adverse treatment outcomes might unpredictably occur anytime and anywhere. Therefore, continual effort to effectively execute DOTS should be strengthened and special follow-up mechanism should be in place to monitor treatment response of retreatment cases.
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Affiliation(s)
- Fentabil Getnet
- Department of Public Health, College of Health Sciences, Jigjiga University, Jigjiga, Ethiopia
| | - Henok Sileshi
- Department of Medical Microbiology, School of Medicine, Jigjiga University, Jigjiga, Ethiopia
| | - Wubareg Seifu
- Department of Public Health, College of Health Sciences, Jigjiga University, Jigjiga, Ethiopia
| | - Selam Yirga
- Dagu Consulting & Services, Addis Ababa, Ethiopia
| | - Abere Shiferaw Alemu
- Department of Medical Laboratory Science, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Nsofor CA, Jiang Q, Wu J, Gan M, Liu Q, Zuo T, Zhu G, Gao Q. Transmission is a Noticeable Cause of Resistance Among Treated Tuberculosis Patients in Shanghai, China. Sci Rep 2017; 7:7691. [PMID: 28794425 PMCID: PMC5550506 DOI: 10.1038/s41598-017-08061-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 07/06/2017] [Indexed: 02/07/2023] Open
Abstract
It is generally believed that drug resistance among treated tuberculosis (TB) patients is as a result of acquired drug resistance due to inappropriate treatment. Previous studies have shown that primary drug resistance caused by transmission also plays a role among treated cases. Differentiating the two types of drug resistance will help in developing appropriate strategies for control of drug resistant tuberculosis. In this study, we tested the hypothesis that drug resistance among treated TB patients is mainly caused by primary resistance rather than acquired resistance. Defining resistance profiles by molecular drug susceptibility test, we used Unit Variable Number Tandem Repeats (VNTR) to genotype and Whole Genome Sequencing (WGS) to confirm the accordance of the first and last Mycobacterium tuberculosis isolates from treated pulmonary TB patients in Shanghai from 2009–2015. Among 81 patients with increasing drug resistance, out of 390 patients enrolled, paired isolates from 59.3% (48/81) had different VNTR patterns indicating primary drug resistance. Our results have demonstrated that primary resistance due to exogenous reinfection is the major cause of drug resistance among treated TB patients in Shanghai; thus, strategies aimed at preventing and interrupting transmission are urgently needed to effectively reduce the epidemic of drug resistant tuberculosis.
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Affiliation(s)
- Chijioke A Nsofor
- School of Basic Medicine, Key Laboratory of Medical Molecular Virology of Ministries of Education and Health, Fudan University, Shanghai, China
| | - Qi Jiang
- School of Basic Medicine, Key Laboratory of Medical Molecular Virology of Ministries of Education and Health, Fudan University, Shanghai, China
| | - Jie Wu
- Department of Tuberculosis Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Mingyu Gan
- School of Basic Medicine, Key Laboratory of Medical Molecular Virology of Ministries of Education and Health, Fudan University, Shanghai, China
| | - Qingyun Liu
- School of Basic Medicine, Key Laboratory of Medical Molecular Virology of Ministries of Education and Health, Fudan University, Shanghai, China
| | - Tianyu Zuo
- School of Basic Medicine, Key Laboratory of Medical Molecular Virology of Ministries of Education and Health, Fudan University, Shanghai, China
| | - Guofeng Zhu
- Department of Tuberculosis Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China.
| | - Qian Gao
- School of Basic Medicine, Key Laboratory of Medical Molecular Virology of Ministries of Education and Health, Fudan University, Shanghai, China.
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Kempker RR, Heinrichs MT, Nikolaishvili K, Sabulua I, Bablishvili N, Gogishvili S, Avaliani Z, Tukvadze N, Little B, Bernheim A, Read TD, Guarner J, Derendorf H, Peloquin CA, Blumberg HM, Vashakidze S. Lung Tissue Concentrations of Pyrazinamide among Patients with Drug-Resistant Pulmonary Tuberculosis. Antimicrob Agents Chemother 2017; 61:e00226-17. [PMID: 28373198 PMCID: PMC5444116 DOI: 10.1128/aac.00226-17] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 03/23/2017] [Indexed: 12/15/2022] Open
Abstract
Improved knowledge regarding the tissue penetration of antituberculosis drugs may help optimize drug management. Patients with drug-resistant pulmonary tuberculosis undergoing adjunctive surgery were enrolled. Serial serum samples were collected, and microdialysis was performed using ex vivo lung tissue to measure pyrazinamide concentrations. Among 10 patients, the median pyrazinamide dose was 24.7 mg/kg of body weight. Imaging revealed predominant lung lesions as cavitary (n = 6 patients), mass-like (n = 3 patients), or consolidative (n = 1 patient). On histopathology examination, all tissue samples had necrosis; eight had a pH of ≤5.5. Tissue samples from two patients were positive for Mycobacterium tuberculosis by culture (pH 5.5 and 7.2). All 10 patients had maximal serum pyrazinamide concentrations within the recommended range of 20 to 60 μg/ml. The median lung tissue free pyrazinamide concentration was 20.96 μg/ml. The median tissue-to-serum pyrazinamide concentration ratio was 0.77 (range, 0.54 to 0.93). There was a significant inverse correlation between tissue pyrazinamide concentrations and the amounts of necrosis (R = -0.66, P = 0.04) and acid-fast bacilli (R = -0.75, P = 0.01) identified by histopathology. We found good penetration of pyrazinamide into lung tissue among patients with pulmonary tuberculosis with a variety of radiological lesion types. Our tissue pH results revealed that most lesions had a pH conducive to pyrazinamide activity. The tissue penetration of pyrazinamide highlights its importance in both drug-susceptible and drug-resistant antituberculosis treatment regimens.
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Affiliation(s)
- Russell R Kempker
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | | | - Irina Sabulua
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
| | - Nino Bablishvili
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
| | - Shota Gogishvili
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
| | - Zaza Avaliani
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
| | - Nestani Tukvadze
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
| | - Brent Little
- Department of Radiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Adam Bernheim
- Department of Radiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Timothy D Read
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jeannette Guarner
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Hartmut Derendorf
- University of Florida, College of Pharmacy, Gainesville, Florida, USA
| | | | - Henry M Blumberg
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Departments of Epidemiology and Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Sergo Vashakidze
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
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Bastos ML, Lan Z, Menzies D. An updated systematic review and meta-analysis for treatment of multidrug-resistant tuberculosis. Eur Respir J 2017; 49:49/3/1600803. [PMID: 28331031 DOI: 10.1183/13993003.00803-2016] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 01/10/2017] [Indexed: 11/05/2022]
Abstract
This systematic review aimed to update the current evidence for multidrug-resistant tuberculosis (MDR-TB) treatment.We searched for studies that reported treatment information and clinical characteristics for at least 25 patients with microbiologically confirmed pulmonary MDR-TB and either end of treatment outcomes, 6-month culture conversion or severe adverse events (SAEs). We assessed the association of these outcomes with patients' characteristics or treatment parameters. We identified 74 studies, including 17 494 participants.The pooled treatment success was 26% in extensively drug-resistant TB (XDR-TB) patients and 60% in MDR-TB patients. Treatment parameters such as number or duration and individual drugs were not associated with improved 6-month sputum culture conversion or end of treatment outcomes. However, MDR-TB patients that received individualised regimens had higher success than patients who received standardised regimens (64% versus 52%; p<0.0.01). When reports from 20 cohorts were pooled, proportions of SAE ranged from 0.5% attributed to ethambutol to 12.2% attributed to para-aminosalicylic acid. The lack of significant associations of treatment outcomes with specific drugs or regimens may reflect the limitations of pooling the data rather than a true lack of differences in efficacy of regimens or individual drugs.This analysis highlights the need for stronger evidence for treatment of MDR-TB from better-designed and reported studies.
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Affiliation(s)
- Mayara Lisboa Bastos
- Internal Medicine Graduate Program, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Zhiyi Lan
- Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University, Montreal, QC, Canada
| | - Dick Menzies
- Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University, Montreal, QC, Canada
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[Prevalence of Mycobacterium tuberculosis resistance to quinolones and injectables in Colombia, 2012-2013]. BIOMEDICA 2017; 37:96-103. [PMID: 28527253 DOI: 10.7705/biomedica.v37i2.3204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 05/18/2016] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Tuberculosis is a health problem worldwide. The World Health Organization estimated 9.6 million new cases and 480,000 multirresistant cases for 2014. The assessment of resistance to quinolones and injectables was implemented only a few years ago, so its prevalence is not known. OBJECTIVE To determine the prevalence of resistance to amikacin, capreomycin and ofloxacin in cases of tuberculosis resistant to isoniazid and/or rifampin during 2012-2013. MATERIALS AND METHODS This was a cross-sectional study of 489 isolates resistant to isoniazid and/or rifampin. We used the Bactec MGITTM technique for susceptibility tests. For analyzing the rate of resistance, we grouped cases according to the history of treatment with second line drugs. RESULTS In the 438 new cases, the drug that showed greater overall resistance was kanamycin with 7.1 % (95% CI: 4.6 to 9.6). In 51 previously treated cases, this highest resistance was 27.5 % (95% CI:14.2 to 40.7). The overall resistance was higher in cases with a history of treatment with quinolones and injectables. We found seven cases of extremely resistant tuberculosis. CONCLUSION This study demonstrates the presence of resistance to second line drugs in people with drug-resistant tuberculosis with and without previous treatment with quinolones and/or injectables, these latter having a higher percentage of resistance. For that reason, it is essential to perform susceptibility testing and analyze this information routinely.
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Kendall EA, Cohen T, Mitnick CD, Dowdy DW. Second line drug susceptibility testing to inform the treatment of rifampin-resistant tuberculosis: a quantitative perspective. Int J Infect Dis 2016; 56:185-189. [PMID: 28007660 DOI: 10.1016/j.ijid.2016.12.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 12/05/2016] [Accepted: 12/06/2016] [Indexed: 11/28/2022] Open
Abstract
Treatment failure and resistance amplification are common among patients with rifampin-resistant tuberculosis (TB). Drug susceptibility testing (DST) for second-line drugs is recommended for these patients, but logistical difficulties have impeded widespread implementation of second-line DST in many settings. To provide a quantitative perspective on the decision to scale up second-line DST, we synthesize literature on the prevalence of second-line drug resistance, the expected clinical and epidemiologic benefits of using second-line DST to ensure that patients with rifampin-resistant TB receive effective regimens, and the costs of implementing (or not implementing) second-line DST for all individuals diagnosed with rifampin-resistant TB. We conclude that, in most settings, second-line DST could substantially improve treatment outcomes for patients with rifampin-resistant TB, reduce transmission of drug-resistant TB, prevent amplification of drug resistance, and be affordable or even cost-saving. Given the large investment made in each patient treated for rifampin-resistant TB, these payoffs would come at relatively small incremental cost. These anticipated benefits likely justify addressing the real challenges faced in implementing second-line DST in most high-burden settings.
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Affiliation(s)
- Emily A Kendall
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, PCTB Suite 211, 725 N. Wolfe St, Baltimore, MD 21205, USA.
| | - Ted Cohen
- Department of Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT 06510, USA.
| | - Carole D Mitnick
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntin, gton Ave., Boston, MA, USA.
| | - David W Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615N. Wolfe St., Baltimore, MD 21205, USA.
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50
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Snow Setzer M, Sharifi-Rad J, Setzer WN. The Search for Herbal Antibiotics: An In-Silico Investigation of Antibacterial Phytochemicals. Antibiotics (Basel) 2016; 5:E30. [PMID: 27626453 PMCID: PMC5039526 DOI: 10.3390/antibiotics5030030] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 08/14/2016] [Accepted: 08/26/2016] [Indexed: 01/12/2023] Open
Abstract
Recently, the emergence and spread of pathogenic bacterial resistance to many antibiotics (multidrug-resistant strains) have been increasing throughout the world. This phenomenon is of great concern and there is a need to find alternative chemotherapeutic agents to combat these antibiotic-resistant microorganisms. Higher plants may serve as a resource for new antimicrobials to replace or augment current therapeutic options. In this work, we have carried out a molecular docking study of a total of 561 antibacterial phytochemicals listed in the Dictionary of Natural Products, including 77 alkaloids (17 indole alkaloids, 27 isoquinoline alkaloids, 4 steroidal alkaloids, and 28 miscellaneous alkaloids), 99 terpenoids (5 monoterpenoids, 31 sesquiterpenoids, 52 diterpenoids, and 11 triterpenoids), 309 polyphenolics (87 flavonoids, 25 chalcones, 41 isoflavonoids, 5 neoflavonoids, 12 pterocarpans, 10 chromones, 7 condensed tannins, 11 coumarins, 30 stilbenoids, 2 lignans, 5 phenylpropanoids, 13 xanthones, 5 hydrolyzable tannins, and 56 miscellaneous phenolics), 30 quinones, and 46 miscellaneous phytochemicals, with six bacterial protein targets (peptide deformylase, DNA gyrase/topoisomerase IV, UDP-galactose mutase, protein tyrosine phosphatase, cytochrome P450 CYP121, and NAD⁺-dependent DNA ligase). In addition, 35 known inhibitors were docked with their respective targets for comparison purposes. Prenylated polyphenolics showed the best docking profiles, while terpenoids had the poorest. The most susceptible protein targets were peptide deformylases and NAD⁺-dependent DNA ligases.
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Affiliation(s)
- Mary Snow Setzer
- Department of Chemistry, University of Alabama in Huntsville, Huntsville, AL 35899, USA.
| | - Javad Sharifi-Rad
- Zabol Medicinal Plants Research Center, Zabol University of Medical Sciences, Zabol 61615-585, Iran.
- Department of Pharmacognosy, Zabol University of Medical Sciences, Zabol 61615-585, Iran.
| | - William N Setzer
- Department of Chemistry, University of Alabama in Huntsville, Huntsville, AL 35899, USA.
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