Treatment outcomes of multidrug-resistant tuberculosis patients receiving ambulatory treatment in Shenzhen, China: a retrospective cohort study

Frontiers in superbug management: innovating approaches to combat antimicrobial resistance

Anti-microbial resistance (AMR) is a global health issue causing significant mortality and economic burden. Pharmaceutical companies' discontinuation of research hinders new agents, while MDR pathogens or "superbugs" worsen the problem. Superbugs pose a threat to common infections and medical procedures, exacerbated by limited antibiotic development and rapid antibiotic resistance. The rising tide of antimicrobial resistance threatens to undermine progress in controlling infectious diseases. This review examines the global proliferation of AMR, its underlying mechanisms, and contributing factors. The study explores various methodologies, emphasizing the significance of precise and timely identification of resistant strains. We discuss recent advancements in CRISPR/Cas9, nanoparticle technology, light-based techniques, and AI-powered antibiogram analysis for combating AMR. Traditional methods often fail to effectively combat multidrug-resistant bacteria, as CRISPR-Cas9 technology offers a more effective approach by cutting specific DNA sequences, precision targeting and genome editing. AI-based smartphone applications for antibiogram analysis in resource-limited settings face challenges like internet connectivity, device compatibility, data quality, energy consumption, and algorithmic limitations. Additionally, light-based antimicrobial techniques are increasingly being used to effectively kill antibiotic-resistant microbial species and treat localized infections. This review provides an in-depth overview of AMR covering epidemiology, evolution, mechanisms, infection prevention, control measures, antibiotic access, stewardship, surveillance, challenges and emerging non-antibiotic therapeutic approaches.

Evaluation of a modified short all oral treatment regimen for rifampicin-multidrug resistant tuberculosis in Dominican Republic

BACKGROUND

This study aims to evaluate the effectiveness, safety, and impact on health-related quality of life (HQoL) of a fully oral shortened regimen for Rifampicin-Resistant/Multidrug-Resistant Tuberculosis (RR/MDR-TB) over 9 to 12 months under programmatic conditions.

METHODS

A prospective cohort study was conducted on an all-oral modified Shortened Treatment Regimen (mSTR) comprising linezolid (Lzd), bedaquiline (Bdq), levofloxacin (Lfx), clofazimine (Cfz), and cycloserine (Cs). Patients with RR/MDR-TB were enrolled between January and December 2022 across seven drug-resistant TB units in the Dominican Republic.

RESULTS

A total of 113 patients were enrolled, with 87% achieving culture conversion at two months. Treatment outcomes revealed that 79% of patients were successfully treated and didn't relapse six months after the end of the treatment, 14% were lost to follow-up during the treatment, 6% deceased, and one experienced treatment failure due to Adverse Drug Reactions (ADRs). Adverse events of Special interest (AESI) were common, with 82% of patients experiencing at least one AE with high proportion of QT interval prolongation, elevated transaminases, and anemia. A total of 12% of the patients experiencing Serious Adverse Events (SAEs). Improvement in HQoL dimensions was noted throughout treatment, with the EQ-VAS score increasing by an average of 15.5 by treatment end.

CONCLUSION

The high treatment success rate of the 5-drug mSTR facilitated the adaptation and integration of a shortened treatment regimen lasting 9 to 12 months in routine care in Dominican Republic. SAEs were -rare. Although AESI were frequent, they were manageable in most cases. Continuous monitoring, particularly with regard to the use of Lzd and Bdq, is crucial to effectively mitigating risks. Since September 2023, this short all oral treatment regimen is the recommended approach for patients with RR/MDR-TB in the Dominican Republic.

Tuberculosis disease burden in China: a spatio-temporal clustering and prediction study

Introduction

The primary aim of this study is to investigate and predict the prevalence and determinants of tuberculosis disease burden in China. Leveraging high-quality data sources and employing a methodologically rigorous approach, the study endeavors to enhance our understanding of tuberculosis control efforts across different regions of China. First, through nationwide spatio-temporal cluster analysis, we summarized the status of tuberculosis burden in various regions of China and explore the differences, thereby providing a basis for formulating more targeted tuberculosis prevention and control policies in different regions; Subsequently, using a time series-based forecasting model, we conducted the first-ever national tuberculosis burden trend forecast to offer scientific guidance for timely adjustments in planning and resource allocation. This research seeks to contribute significantly to China's existing tuberculosis prevention and control system.

Materials and methods

This research draws upon publicly available pulmonary tuberculosis (PTB) incidence and mortality statistics from 31 provinces and municipalities of mainland China between 2004 and 2018. We organized and classified these data according to province, month, year, and patient age group. Overall, the sample included 14,816,329 new instances of PTB and 42,465 PTB-related fatalities. We used spatiotemporal cluster analysis to record the epidemiological characteristics and incidence patterns of PTB during this period. Additionally, a time series model was constructed to forecast and analyze the incidence and mortality trends of PTB in China.

Results

This study reveals significant regional variations in PTB incidence and mortality in China. Tibet (124.24%) and Xinjiang (114.72%) in western China exhibited the largest percentage change in tuberculosis (TB) incidence, while Zhejiang Province (-50.45%) and Jiangsu Province (-51.33%) in eastern China showed the largest decreases. Regions with significant percentage increases in PTB mortality rates (>100%) included four western regions, six central regions, and five eastern regions. The regions with relatively large percentage decreases in the mortality rate of PTB include Tianjin (-52.25%) and Shanghai (-68.30%). These differences are attributed to two main factors: (1) economic imbalances leading to poor TB control in underdeveloped areas, and (2) differences in TB-related policies among provinces causing uneven distribution of disease risks. Consequently, China may still face challenges in achieving the World Health Organization's 2030 tuberculosis control goals. Nationwide, the mortality rate of PTB in China increased between 2004 and 2018 (percentage change: 105.35%, AAPC: 4.1), while the incidence of PTB showed a downward trend (percentage change: -20.59%, AAPC: -2.1). Among different age groups, the 0-19 age group has the smallest disease burden. While incidence and mortality from TB were primarily found in adults 60 years of age or older, the age group of 0-19 years has the smallest burden of TB, highlighting obvious differences in age characteristics. It is predicted that the mortality rate of TB in China will continue to increase. In summary, the TB epidemic in China has been largely controlled due to the implementation of many public health programs and policies targeting specific groups and geographical areas. Finding and supporting effective health programs will make it possible to achieve the World Health Organization's goal of controlling tuberculosis in China.

Predictors of poor treatment outcomes among drug-resistant tuberculosis patients in Hunan province, China

Background

Drug-resistant tuberculosis (DR-TB) is a significant public health concern, often resulting in poor treatment outcomes. This study aims to identify predictors of poor treatment outcomes among patients with DR-TB in Hunan Province, China.

Methods

A retrospective cohort study was conducted in Hunan Province using data collected between 2013 and 2018 among patients with DR-TB treatment. Univariable and multivariable parametric survival analyses were performed using a shared frailty survival model with a Weibull distribution and Gamma frailty to identify determinants of poor treatment outcomes. Adjusted hazard ratios (AHR) with a 95 % confidence interval (CI) were calculated for the best-fitted model. The goodness of fit for the model was assessed using the Cox-Snell residual test.

Results

A total of 1384 bacteriologically confirmed DR-TB patients were included in the analysis. Of these, 9.97 % (95 % CI: 8.05-11.67 %) experienced poor treatment outcomes. The hazard of poor treatment outcomes was significantly higher among patients with a history of previous TB treatment compared to those with new TB (AHR = 1.82, 95 % CI: 1.27-2.61). Additionally, each one-day delay in diagnosis was associated with a slightly increased hazard of poor treatment outcomes (AHR = 1.00034, 95 % CI:1.000041-1.00064). Patients who received medication supervision and consistent treatment follow-up (i.e., systematic management) had a significantly lower hazard of poor treatment outcomes than those without systematic management (AHR = 0.08, 95 % CI: 0.05-0.14).

Conclusion

A substantial proportion of DR-TB patients in Hunan Province experience poor treatment outcomes, with prior TB treatment and delays in diagnosis being key predictors. Early diagnosis and systematic management, including medication supervision and consistent follow-up, significantly reduce the risk of poor treatment outcomes. Focused interventions for previously treated TB cases are crucial to improving treatment outcomes and mitigating the risk of long-term physical sequelae among DR-TB survivors.

Treatment Outcomes and Associated Influencing Factors Among Patients with Rifampicin-Resistant Tuberculosis: A Multicenter, Retrospective, Cohort Study in China

Objective

Rifampin-resistant tuberculosis (RR-TB) remains a serious global public health concern. We assessed treatment outcomes and associated influencing factors among RR-TB patients in China.

Methods

This research enrolled 1339 patients who started RR-TB treatment between May 2018 and April 2020 in China retrospectively. Data were collected from the electronic medical records. Multivariable logistic regression analysis was used to identify the influencing factors related to unfavorable outcomes.

Results

Of the 1339 RR-TB patients, 78.8% (1055/1339) achieved treatment success (cured or treatment completed), 5.1% (68/1339) experienced treatment failure, 1.1% (15/1339) died during treatment, 10.1% (135/1339) were lost to follow-up, and 4.9% (66/1339) were not evaluated. About 67.7% (907/1339) of patients experienced at least one adverse event (AE). The most common AE was hypohepatia (507/1339, 37.9%), followed by hyperuricemia (429/1339, 32.0%), anemia (368/1339, 27.5%), electrolyte disturbance (318/1339, 23.7%), peripheral neuritis (245/1339, 18.3%), and gastrointestinal reactions (203/1339, 15.2%). Multivariate analysis showed that age ≥60 years [adjusted odds ratio (aOR): 1.96, 95% confidence interval (CI): 1.39-2.77], national minority (aOR: 2.36, 95% CI: 1.42-3.93), smoking (aOR: 1.50, 95% CI: 1.10-2.04), cardiopathy (aOR: 2.90, 95% CI: 1.33-6.31), tumors (aOR: 9.84, 95% CI: 2.27-42.67), immunocompromise (aOR: 2.17, 95% CI: 1.21-3.91), re-treated TB (aOR: 1.46, 95% CI: 1.08-1.97), and experienced gastrointestinal reactions (aOR: 2.27, 95% CI: 1.52-3.40) were associated with unfavorable outcomes. Body mass index (BMI) ≥18.5 kg/m2, regimens containing bedaquiline and experienced adverse events (AEs) such as hypohepatia, leukopenia, peripheral neuritis, and optic neuritis were associated with favorable outcomes.

Conclusion

High rates of treatment success were achieved for RR-TB patients at tertiary tuberculosis hospitals in China. Age ≥60 years, national minority, smoking status, comorbidities, re-treated TB, and experienced gastrointestinal reactions were independent prognostic factors for unfavorable treatment outcomes.

A Comprehensive Review on Long vs. Short Regimens in Multidrug-Resistant Tuberculosis (MDR-TB) Under Programmatic Management of Drug-Resistant Tuberculosis (PMDT)

This comprehensive review delves into the intricate landscape of multidrug-resistant tuberculosis (MDR-TB) treatment within the programmatic management of drug-resistant tuberculosis (PMDT) framework. MDR-TB poses a substantial global health threat, necessitating targeted approaches for effective management. The analysis explores the historical evolution, efficacy, safety profiles, and implementation challenges associated with long and short regimens. The findings underscore the importance of individualized clinical practices, considering patient-specific factors, and the need for ongoing monitoring within PMDT programs. Recommendations advocate for integrating advanced diagnostics, continuous surveillance, and training for healthcare professionals. The review concludes with a nuanced outlook on long versus short regimens, emphasizing a balanced approach and the imperative role of collaborative efforts in shaping the future of MDR-TB treatment. This synthesis contributes to the ongoing discourse, providing valuable insights for healthcare practitioners, policymakers, and researchers working toward optimizing outcomes for individuals afflicted with MDR-TB.

Nano vs Resistant Tuberculosis: Taking the Lung Route

Tuberculosis (TB) is among the top 10 infectious diseases worldwide. It is categorized among the leading killer diseases that are the reason for the death of millions of people globally. Although a standardized treatment regimen is available, non-adherence to treatment has increased multi-drug resistance (MDR) and extensive drug-resistant (XDR) TB development. Another challenge is targeting the death of TB reservoirs in the alveoli via conventional treatment. TB Drug resistance may emerge as a futuristic restraint of TB with the scarcity of effective Anti-tubercular drugs. The paradigm change towards nano-targeted drug delivery systems is mostly due to the absence of effective therapy and increased TB infection recurrent episodes with MDR. The emerging field of nanotechnology gave an admirable opportunity to combat MDR and XDR via accurate diagnosis with effective treatment. The new strategies targeting the lung via the pulmonary route may overcome the new incidence of MDR and enhance patient compliance. Therefore, this review highlights the importance and recent research on pulmonary drug delivery with nanotechnology along with prevalence, the need for the development of nanotechnology, beneficial aspects of nanomedicine, safety concerns of nanocarriers, and clinical studies.

Assessment of Comorbidity in Patients with Drug-Resistant Tuberculosis

A wide range of comorbidities, especially in multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) patients, markedly complicates selecting effective treatment of tuberculosis (TB) and preventing the development of adverse events. At present, it is impossible to assess the severity of comorbid pathologies and develop indications for the administration of accompanying therapy in TB patients. The aim of this study was to identify the difference in the range of comorbidities between patients with MDR-TB and XDR-TB and assess the impact of comorbidities on TB treatment. Materials and Methods: A retrospective, prospective study was conducted where 307 patients with MDR-TB and XDR-TB pulmonary tuberculosis aged 18 to 75 years who received eTB treatment from 2016 to 2021 in St. Petersburg hospitals were analyzed. The analysis showed that the comorbidity level in MDR-TB and XDR-TB patients with TB treatment success and treatment failure was comparable with the use of the Charlson Comorbidity Index (CCI). The CCI demonstrated declining data in terms of TB treatment outcome period in both groups. A slight predominance of CCI score (3 to 4 points) in XDR-TB (22.7%) vs. MDR-TB (15.4%) patients was found. In the case of an TB treatment failure, the CCI level in MDR-TB vs. XDR-TB patients was characterized by a significantly higher rate of low magnitude (ranging from 1 to 2 points) in 21.1% vs. 4.5% (p < 0.05), which was higher in XDR-TB patients (ranging from 4 to 5 points, in 10.0% vs. 0, χ2 = 33.7 (p < 0.01)). Chronic viral hepatitis B and C infection, cardiovascular pathology, chronic obstructive pulmonary disease, and chronic alcoholism were found to be significant comorbidity factors that influenced the TB treatment success. Conclusions: It is evident that XDR-TB patients comprise a cohort with the most severe disease course due to comorbidities impacting TB treatment efficacy. The obtained data pointed to the need to determine comorbidity severity in patients with drug-resistant Mbt prior to administering TB treatment schemes.