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Vasquez A, Mitnick C, Nyaruhirira AU, Chiang CY, Horsburgh CR. A survey of the effectiveness of centralized consilia in providing advice on drug-resistant TB. IJTLD OPEN 2024; 1:329-331. [PMID: 39035429 PMCID: PMC11257094 DOI: 10.5588/ijtldopen.24.0228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 06/03/2024] [Indexed: 07/23/2024]
Affiliation(s)
- A Vasquez
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - C Mitnick
- Department of Global Health & Social Medicine, Harvard Medical School, Boston, MA, USA
| | - A U Nyaruhirira
- Management Sciences for Health, Center for Pharmaceutical Management, Pretoria, South Africa
| | - C-Y Chiang
- Department of Internal Medicine, Taipei Municipal Wan-Fang Hospital, Taipei, Taiwan
| | - C R Horsburgh
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
- Departments of Epidemiology and Biostatistics, Boston University School of Public Health, Boston, MA, USA
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Iskandar D, Pradipta IS, Anggriani A, Postma MJ, van Boven JFM. Multidisciplinary tuberculosis care: leveraging the role of hospital pharmacists. BMJ Open Respir Res 2023; 10:e001887. [PMID: 37949612 PMCID: PMC10649469 DOI: 10.1136/bmjresp-2023-001887] [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: 06/14/2023] [Accepted: 10/31/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION Optimal pharmacological treatment of tuberculosis (TB) requires a multidisciplinary team, yet the hospital pharmacist's role is unclear. We aimed to analyse hospital pharmacist-provided clinical pharmacy services (CPS) implementation in TB care. METHOD A nationwide survey-based online cross-sectional study was conducted on hospital pharmacists in Indonesia from 1 November 2022 to 22 November 2022. Outcomes were the extent of pharmacists' involvement in multidisciplinary TB care, TB-related CPS provided and views on TB-related CPS. The probability of pharmacists' involvement in multidisciplinary TB teams was assessed using logistic regression. RESULTS In total, 439 pharmacists (mean age 31.2±6.22 years, 78% female) completed the survey. Thirty-six per cent were part of multidisciplinary TB care, and 23% had TB-related tasks. Adherence monitoring (90%) and drug use evaluation (86%) were the most conducted TB-related CPS. Pharmacists' views on TB-related CPS implementation were generally positive, except for financial incentives. Work experience (OR 1.99, 95% CI 1.09 to 3.61), ever received TB-related training (OR 3.51, 95% CI 2.03 to 6.14) and specific assignments to provide TB-related CPS (OR 8.42, 95% CI 4.99 to 14.59) significantly increased pharmacist involvement in multidisciplinary TB care. CONCLUSION Around one-third of hospital pharmacists are part of multidisciplinary TB care, with medication adherence and drug use monitoring as primary tasks. Pharmacists' experience, training, assignment to provide TB-related CPS and financial incentives are key elements for further implementation in multidisciplinary TB care. Pharmacists should proactively support current TB care and conduct operational research, sharing data with healthcare peers and fostering a collaborative multidisciplinary TB care team.
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Affiliation(s)
- Deni Iskandar
- Unit of Global Health, Department of Health Sciences, University of Groningen, University Medical Center, Groningen, The Netherlands
- Faculty of Pharmacy, Bhakti Kencana University, Bandung, Indonesia
| | - Ivan S Pradipta
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Padjadjaran University, Bandung, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Bandung, Indonesia
- Indonesian Tuberculosis Research Network/JetSet TB, Bandung, Indonesia
| | - Ani Anggriani
- Faculty of Pharmacy, Bhakti Kencana University, Bandung, Indonesia
| | - Maarten J Postma
- Unit of Global Health, Department of Health Sciences, University of Groningen, University Medical Center, Groningen, The Netherlands
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Bandung, Indonesia
- Research Institute Science in Healthy Aging and healthcaRE (SHARE), University of Groningen, University Medical Center, Groningen, The Netherlands
- Department of Economics, Econometrics & Finance, Faculty of Economic & Business, University of Groningen, Groningen, Netherlands
| | - Job F M van Boven
- Department of Clinical Pharmacy & Pharmacology, University of Groningen, University Medical Center, Groningen, The Netherlands
- Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center, Groningen, The Netherlands
- Center for Medicine Use and Safety, Monash Institute of Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
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Eimer J, Fréchet-Jachym M, Le Dû D, Caumes E, El-Helali N, Marigot-Outtandy D, Mechai F, Peytavin G, Pourcher V, Rioux C, Yazdanpanah Y, Robert J, Guglielmetti L. Association Between Increased Linezolid Plasma Concentrations and the Development of Severe Toxicity in Multidrug-Resistant Tuberculosis Treatment. Clin Infect Dis 2023; 76:e947-e956. [PMID: 35717636 DOI: 10.1093/cid/ciac485] [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: 03/24/2022] [Revised: 05/29/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Treatment of multidrug-resistant (MDR) tuberculosis with linezolid is characterized by high rates of adverse events. Evidence on therapeutic drug monitoring to predict drug toxicity is scarce. This study aimed to evaluate the association of linezolid trough concentrations with severe toxicity. METHODS We retrospectively assessed consecutive patients started on linezolid for MDR tuberculosis between 2011 and 2017. The primary outcome was severe mitochondrial toxicity (SMT) due to linezolid, defined as neurotoxicity or myelotoxicity leading to drug discontinuation. The impact of plasma linezolid trough concentrations >2 mg/L was assessed in multivariate Cox proportional hazards models including time-varying covariates. RESULTS SMT occurred in 57 of 146 included patients (39%) at an incidence rate of 0.38 per person-year (95% confidence interval, .30-.49). A maximum linezolid trough concentration >2 mg/L was detected in 52 patients (35.6%), while the mean trough concentration was >2 mg/L in 22 (15%). The adjusted hazard ratio for SMT was 2.35 (95% confidence interval, 1.26-4.38; P = .01) in patients with a mean trough concentration >2 mg/L and 2.63 (1.55-4.47; P < .01) for SMT after the first detection of a trough concentration >2 mg/L. In an exploratory analysis, higher maximum trough concentrations were dose-dependently associated with toxicity, while lowering elevated trough concentrations did not restore baseline risk. CONCLUSIONS Linezolid trough concentrations >2 mg/L are strongly associated with the development of severe treatment-emergent toxicity in patients treated for MDR tuberculosis. Pending further prospective evidence, an individual risk-benefit assessment on the continuation of linezolid treatment is warranted in any patient with trough concentrations >2 mg/L.
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Affiliation(s)
- Johannes Eimer
- INSERM, U1135, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Équipe 2, Sorbonne Université, Paris, France
| | | | - Damien Le Dû
- Sanatorium, Centre Hospitalier de Bligny, Briis-sous-Forges, France
| | - Eric Caumes
- Service de Maladies Infectieuses et Tropicales, Hôpital Pitié-Salpêtrière, AP-HP.Sorbonne Université, Paris, France
| | - Najoua El-Helali
- Plateforme de Dosage des Anti-infectieux, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Dhiba Marigot-Outtandy
- Sanatorium, Centre Hospitalier de Bligny, Briis-sous-Forges, France.,AP-HP, Service de Maladies Infectieuses, Hôpital Raymond Poincaré, Université de Saint-Quentin en Yvelines, Garches, France
| | - Frédéric Mechai
- AP-HP, Service de Maladies Infectieuses et Tropicales, Hôpital Avicenne, Paris, France.,IAME INSERM UMR-S 1137, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
| | - Gilles Peytavin
- Laboratoire de Pharmacologie-Toxicologie, DMU Biologie et Génomique Médicale (BioGeM), IAME INSERM UMR-S 1137, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
| | - Valérie Pourcher
- Service de Maladies Infectieuses et Tropicales, Hôpital Pitié-Salpêtrière, AP-HP.Sorbonne Université, Paris, France
| | - Christophe Rioux
- AP-HP, Service de Maladies Infectieuses et Tropicales, Hôpital Bichat-Claude Bernard, Paris, France
| | - Yazdan Yazdanpanah
- AP-HP, Service de Maladies Infectieuses et Tropicales, Hôpital Bichat-Claude Bernard, Paris, France
| | - Jérôme Robert
- INSERM, U1135, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Équipe 2, Sorbonne Université, Paris, France.,Hôpital Pitié-Salpêtrière, Laboratoire de Bactériologie-Hygiène, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, AP-HP.Sorbonne Université, Paris, France
| | - Lorenzo Guglielmetti
- INSERM, U1135, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Équipe 2, Sorbonne Université, Paris, France.,Hôpital Pitié-Salpêtrière, Laboratoire de Bactériologie-Hygiène, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, AP-HP.Sorbonne Université, Paris, France
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Bothamley GH. Multidrug-resistant tuberculosis: diagnosis, checklists, adverse events, advice and outcomes. ERJ Open Res 2022; 8:00512-2022. [PMID: 36451839 PMCID: PMC9703147 DOI: 10.1183/23120541.00512-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 10/04/2022] [Indexed: 11/29/2022] Open
Abstract
The account of MDR-TB in Finland describes current practice. Genetic testing of primary specimens, whole-genome sequencing, supportive directly observed therapy, checklists and national consilia will contribute to further improvements in managing MDR-TB. https://bit.ly/3rOnb3u.
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Affiliation(s)
- Graham H. Bothamley
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Blizard Institute, Queen Mary University of London, London, UK
- Homerton University Hospital, London, UK
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Kherabi Y, Fréchet-Jachym M, Rioux C, Yazdanpanah Y, Méchaï F, Pourcher V, Robert J, Guglielmetti L. Revised Definitions of Tuberculosis Resistance and Treatment Outcomes, France, 2006-2019. Emerg Infect Dis 2022; 28:1796-1804. [PMID: 35997386 PMCID: PMC9423894 DOI: 10.3201/eid2809.220458] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Definitions of resistance in multidrug-resistant tuberculosis (MDR TB) and extensively drug-resistant tuberculosis (XDR TB) have been updated. Pre-XDR TB, defined as MDR TB with additional resistance to fluoroquinolones, and XDR TB, with additional resistance to bedaquiline or linezolid, are frequently associated with treatment failure and toxicity. We retrospectively determined the effects of pre-XDR/XDR TB resistance on outcomes and safety of MDR TB treatment in France. The study included 298 patients treated for MDR TB at 3 reference centers during 2006-2019. Of those, 205 (68.8%) cases were fluoroquinolone-susceptible MDR TB and 93 (31.2%) were pre-XDR/XDR TB. Compared with fluoroquinolone-susceptible MDR TB, pre-XDR/XDR TB was associated with more cavitary lung lesions and bilateral disease and required longer treatment. Overall, 202 patients (67.8%) had favorable treatment outcomes, with no significant difference between pre-XDR/XDR TB (67.7%) and fluoroquinolone-susceptible MDR TB (67.8%; p = 0.99). Pre-XDR/XDR TB was not associated with higher risk for serious adverse events.
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Bonnet I, Haddad E, Guglielmetti L, Bémer P, Bernard L, Bourgoin A, Brault R, Catho G, Caumes E, Escaut L, Fourniols E, Fréchet-Jachym M, Gaudart A, Guillot H, Lafon-Desmurs B, Lanoix JP, Lanotte P, Lemaignen A, Lemaire B, Lemaitre N, Michau C, Morand P, Mougari F, Marigot-Outtandy D, Patrat-Delon S, Perpoint T, Piau C, Pourcher V, Zarrouk V, Zeller V, Veziris N, Jauréguiberry S, Aubry A. Clinical Features and Outcome of Multidrug-Resistant Osteoarticular Tuberculosis: A 12-Year Case Series from France. Microorganisms 2022; 10:1215. [PMID: 35744731 PMCID: PMC9229793 DOI: 10.3390/microorganisms10061215] [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: 05/26/2022] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 02/04/2023] Open
Abstract
The optimal treatment for osteoarticular infection due to multidrug-resistant tuberculosis strains (MDR-OATB) remains unclear. This study aims to evaluate the diagnosis, management and outcome of MDR-OATB in France. We present a case series of MDR-OATB patients reviewed at the French National Reference Center for Mycobacteria between 2007 and 2018. Medical history and clinical, microbiological, treatment and outcome data were collected. Twenty-three MDR-OATB cases were reported, representing 3% of all concurrent MDR-TB cases in France. Overall, 17 were male, and the median age was 32 years. Six patients were previously treated for TB, including four with first-line drugs. The most frequently affected site was the spine (n = 16). Bone and joint surgery were required in 12 patients. Twenty-one patients (91%) successfully completed the treatment with a regimen containing a mean of four drugs (range, 2-6) for a mean duration of 20 months (range, 13-27). Overall, high rates of treatment success were achieved following WHO MDR-TB treatment guidelines and individualized patient management recommendations by the French National TB Consilium. However, the optimal combination of drugs, duration of treatment and role of surgery in the management of MDR-OATB remains to be determined.
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Affiliation(s)
- Isabelle Bonnet
- Cimi-Paris, INSERM, U1135, Centre d’Immunologie et des Maladies Infectieuses, Sorbonne Université, 75013 Paris, France; (I.B.); (L.G.); (N.V.)
- Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne-Université, 75013 Paris, France
- TB Consilium of the National Reference Center for Mycobacteria, 75013 Paris, France
| | - Elie Haddad
- Service de Maladies Infectieuses et Tropicales, Hôpital Pitié-Salpêtrière, AP-HP, INSERM 1136, Sorbonne-Université, 75013 Paris, France; (E.H.); (E.C.); (V.P.); (S.J.)
| | - Lorenzo Guglielmetti
- Cimi-Paris, INSERM, U1135, Centre d’Immunologie et des Maladies Infectieuses, Sorbonne Université, 75013 Paris, France; (I.B.); (L.G.); (N.V.)
- Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne-Université, 75013 Paris, France
- TB Consilium of the National Reference Center for Mycobacteria, 75013 Paris, France
| | - Pascale Bémer
- Department of Bacteriology, University Hospital, CHU Nantes, 44000 Nantes, France;
| | - Louis Bernard
- Service de Médecine Interne et Maladies Infectieuses, Centre Hospitalier Régional Universitaire de Tours, 37000 Tours, France; (L.B.); (A.L.)
| | - Anne Bourgoin
- Service de Virologie et Mycobactériologie, Centre Hospitalier Universitaire de Poitiers, 86000 Poitiers, France;
| | - Rachel Brault
- Service de Rhumatologie, Centre Hospitalier Universitaire de Poitiers, 86000 Poitiers, France;
| | - Gaud Catho
- Service de Maladies Infectieuses et Tropicales, Hospices Civils de Lyon, 69002 Lyon, France; (G.C.); (T.P.)
| | - Eric Caumes
- Service de Maladies Infectieuses et Tropicales, Hôpital Pitié-Salpêtrière, AP-HP, INSERM 1136, Sorbonne-Université, 75013 Paris, France; (E.H.); (E.C.); (V.P.); (S.J.)
| | - Lélia Escaut
- Service de Maladies Infectieuses et Tropicales, Hôpital Bicêtre, AP-HP, Université Paris Saclay, 94270 Le Kremlin-Bicêtre, France;
| | - Eric Fourniols
- Service de Chirurgie Orthopédique, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne-Université, 75013 Paris, France;
| | - Mathilde Fréchet-Jachym
- Sanatorium, Centre Hospitalier de Bligny, 91640 Briis-sous-Forges, France; (M.F.-J.); (B.L.); (D.M.-O.)
| | - Alice Gaudart
- Service de Bactériologie, Centre Hospitalier Universitaire de Nice, 06000 Nice, France;
| | - Hélène Guillot
- Service de Médecine Interne, Hôpital Robert Ballanger, 93600 Aulnay-sous-Bois, France;
| | - Barthélémy Lafon-Desmurs
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier de Tourcoing, 59200 Tourcoing, France;
| | - Jean-Philippe Lanoix
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire d’Amiens-Picardie, 80054 Amiens, France;
| | - Philippe Lanotte
- Service de Bactériologie, Centre Hospitalier Universitaire de Tours, 37000 Tours, France;
| | - Adrien Lemaignen
- Service de Médecine Interne et Maladies Infectieuses, Centre Hospitalier Régional Universitaire de Tours, 37000 Tours, France; (L.B.); (A.L.)
| | - Bénédicte Lemaire
- Sanatorium, Centre Hospitalier de Bligny, 91640 Briis-sous-Forges, France; (M.F.-J.); (B.L.); (D.M.-O.)
| | - Nadine Lemaitre
- Service de Bactériologie, Centre Hospitalier Universitaire d’Amiens-Picardie, 59200 Tourcoing, France;
| | - Christophe Michau
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier de Saint-Nazaire, 44606 Saint-Nazaire, France;
| | - Philippe Morand
- Service de Bactériologie, Hôpital Cochin, AP-HP, Centre-Université de Paris, 75014 Paris, France;
| | - Faiza Mougari
- Service de Bactériologie, Hôpital Lariboisière, AP-HP, Nord-Université de Paris, 75018 Paris, France;
| | - Dhiba Marigot-Outtandy
- Sanatorium, Centre Hospitalier de Bligny, 91640 Briis-sous-Forges, France; (M.F.-J.); (B.L.); (D.M.-O.)
| | - Solène Patrat-Delon
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Rennes, 35033 Rennes, France;
| | - Thomas Perpoint
- Service de Maladies Infectieuses et Tropicales, Hospices Civils de Lyon, 69002 Lyon, France; (G.C.); (T.P.)
| | - Caroline Piau
- Service de Bactériologie, Centre Hospitalier Universitaire de Rennes, 35033 Rennes, France;
| | - Valérie Pourcher
- Service de Maladies Infectieuses et Tropicales, Hôpital Pitié-Salpêtrière, AP-HP, INSERM 1136, Sorbonne-Université, 75013 Paris, France; (E.H.); (E.C.); (V.P.); (S.J.)
| | - Virginie Zarrouk
- Service de Médecine Interne, Hôpital Beaujon, AP-HP, Nord-Université de Paris, 92110 Clichy, France;
| | - Valérie Zeller
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses Croix Saint-Simon, 75020 Paris, France;
| | - Nicolas Veziris
- Cimi-Paris, INSERM, U1135, Centre d’Immunologie et des Maladies Infectieuses, Sorbonne Université, 75013 Paris, France; (I.B.); (L.G.); (N.V.)
- Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne-Université, 75013 Paris, France
- TB Consilium of the National Reference Center for Mycobacteria, 75013 Paris, France
- Service de Bactériologie, Hôpitaux Saint-Antoine, Tenon, Trousseau, Rothschild, AP-HP, 75012 Paris, France
| | - Stéphane Jauréguiberry
- Service de Maladies Infectieuses et Tropicales, Hôpital Pitié-Salpêtrière, AP-HP, INSERM 1136, Sorbonne-Université, 75013 Paris, France; (E.H.); (E.C.); (V.P.); (S.J.)
- Service de Maladies Infectieuses et Tropicales, Hôpital Bicêtre, AP-HP, Université Paris Saclay, 94270 Le Kremlin-Bicêtre, France;
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | - Alexandra Aubry
- Cimi-Paris, INSERM, U1135, Centre d’Immunologie et des Maladies Infectieuses, Sorbonne Université, 75013 Paris, France; (I.B.); (L.G.); (N.V.)
- Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne-Université, 75013 Paris, France
- TB Consilium of the National Reference Center for Mycobacteria, 75013 Paris, France
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France
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Kherabi Y, Mollo B, Gerard S, Lescure FX, Rioux C, Yazdanpanah Y. Patient-centered approach to the management of drug-resistant tuberculosis in France: How far off the mark are we? PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000313. [PMID: 36962203 PMCID: PMC10021739 DOI: 10.1371/journal.pgph.0000313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 03/09/2022] [Indexed: 11/18/2022]
Abstract
Drug-resistant tuberculosis (DR-TB) is a major public health concern worldwide. The prolonged isolation required is a source of challenges for both healthcare workers and patients, especially in high-income countries where DR-TB patients are frequently migrants with vulnerabilities. However, data on the needs of these vulnerable patients are scarce. Our objective was to identify and quantify conflict or inappropriate care situations experienced by both DR-TB patients and healthcare workers. This 10-year retrospective observational study (01/2008 to 10/2018) was conducted in a referral center for resistant tuberculosis management in Paris, France. Sixty-five DR-TB patients were hospitalized during the study period. Their demographic, clinical and social characteristics and any conflict or inappropriate care situations they experienced with healthcare workers while hospitalized were analyzed. Conflict or inappropriate care situations with healthcare workers were reported for 24 patients during their stay (36.9%). Eleven patients (16.9%) had difficulty adhering to respiratory isolation rules, 15 (23.1%) were discharged against medical advice, 9 (13.8%) were excluded from hospital for disciplinary reasons, verbal or physical violence was reported for 7 patients (10.8%), and 4 arrests (6.2%) were made by the police. Conflict situations were reported more often when there was a language barrier (70.8%, p<0.0001). More than one-third of patients with DR-TB in this referral center experienced at least one inappropriate care situation with healthcare workers. This study illustrates the urgent need to promote a patient-centered approach and to respond to the challenges of its practical implementation.
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Affiliation(s)
- Yousra Kherabi
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire Bichat-Claude Bernard, Paris, France
- Inserm U1137, IAME, Université de Paris, Paris, France
| | - Bastien Mollo
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire Bichat-Claude Bernard, Paris, France
- Inserm U1137, IAME, Université de Paris, Paris, France
| | - Sandrine Gerard
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire Bichat-Claude Bernard, Paris, France
| | - François-Xavier Lescure
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire Bichat-Claude Bernard, Paris, France
- Inserm U1137, IAME, Université de Paris, Paris, France
| | - Christophe Rioux
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire Bichat-Claude Bernard, Paris, France
- Inserm U1137, IAME, Université de Paris, Paris, France
| | - Yazdan Yazdanpanah
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire Bichat-Claude Bernard, Paris, France
- Inserm U1137, IAME, Université de Paris, Paris, France
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Bonnet I, Enouf V, Morel F, Ok V, Jaffré J, Jarlier V, Aubry A, Robert J, Sougakoff W. A Comprehensive Evaluation of GeneLEAD VIII DNA Platform Combined to Deeplex Myc-TB ® Assay to Detect in 8 Days Drug Resistance to 13 Antituberculous Drugs and Transmission of Mycobacterium tuberculosis Complex Directly From Clinical Samples. Front Cell Infect Microbiol 2021; 11:707244. [PMID: 34778100 PMCID: PMC8586210 DOI: 10.3389/fcimb.2021.707244] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 10/04/2021] [Indexed: 11/21/2022] Open
Abstract
The GeneLEAD VIII (Diagenode, Belgium) is a new, fully automated, sample-to-result precision instrument for the extraction of DNA and PCR detection of Mycobacterium tuberculosis complex (MTBC) directly from clinical samples. The Deeplex Myc-TB® assay (Genoscreen, France) is a diagnostic kit based on the deep sequencing of a 24-plexed amplicon mix allowing simultaneously the detection of resistance to 13 antituberculous (antiTB) drugs and the determination of spoligotype. We evaluated the performance of a strategy combining the both mentioned tools to detect directly from clinical samples, in 8 days, MTBC and its resistance to 13 antiTB drugs, and identify potential transmission of strains from patient-to-patient. Using this approach, we screened 112 clinical samples (65 smear-negative) and 94 MTBC cultured strains. The sensitivity and the specificity of the GeneLEAD/Deeplex Myc-TB approach for MTBC detection were 79.3% and 100%, respectively. One hundred forty successful Deeplex Myc-TB results were obtained for 46 clinical samples and 94 strains, a total of 85.4% of which had a Deeplex Myc-TB susceptibility and resistance prediction consistent with phenotypic drug susceptibility testing (DST). Importantly, the Deeplex Myc-TB assay was able to detect 100% of the multidrug-resistant (MDR) MTBC tested. The lowest concordance rates were for pyrazinamide, ethambutol, streptomycin, and ethionamide (84.5%, 81.5%, 73%, and 55%, respectively) for which the determination of susceptibility or resistance is generally difficult with current tools. One of the main difficulties of Deeplex Myc-TB is to interpret the non-synonymous uncharacterized variants that can represent up to 30% of the detected single nucleotide variants. We observed a good level of concordance between Deeplex Myc-TB-spoligotyping and MIRU-VNTR despite a lower discriminatory power for spoligotyping. The median time to obtain complete results from clinical samples was 8 days (IQR 7–13) provided a high-throughput NGS sequencing platform was available. Our results highlight that the GeneLEAD/Deeplex Myc-TB approach could be a breakthrough in rapid diagnosis of MDR TB in routine practice.
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Affiliation(s)
- Isabelle Bonnet
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Service de Bactériologie-Hygiène, Paris, France.,Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux (CNR-MyRMA), Paris, France.,Sorbonne Université, INSERM, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Unité Mixte de Recherche (UMR) 1135, Paris, France
| | - Vincent Enouf
- Plateforme de Microbiologie Mutualisée (P2M), Pasteur International Bioresources network (PIBnet), Institut Pasteur, Paris, France
| | - Florence Morel
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Service de Bactériologie-Hygiène, Paris, France.,Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux (CNR-MyRMA), Paris, France.,Sorbonne Université, INSERM, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Unité Mixte de Recherche (UMR) 1135, Paris, France
| | - Vichita Ok
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Service de Bactériologie-Hygiène, Paris, France.,Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux (CNR-MyRMA), Paris, France.,Sorbonne Université, INSERM, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Unité Mixte de Recherche (UMR) 1135, Paris, France
| | - Jérémy Jaffré
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Service de Bactériologie-Hygiène, Paris, France.,Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux (CNR-MyRMA), Paris, France.,Sorbonne Université, INSERM, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Unité Mixte de Recherche (UMR) 1135, Paris, France
| | - Vincent Jarlier
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Service de Bactériologie-Hygiène, Paris, France.,Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux (CNR-MyRMA), Paris, France
| | - Alexandra Aubry
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Service de Bactériologie-Hygiène, Paris, France.,Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux (CNR-MyRMA), Paris, France.,Sorbonne Université, INSERM, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Unité Mixte de Recherche (UMR) 1135, Paris, France
| | - Jérôme Robert
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Service de Bactériologie-Hygiène, Paris, France.,Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux (CNR-MyRMA), Paris, France.,Sorbonne Université, INSERM, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Unité Mixte de Recherche (UMR) 1135, Paris, France
| | - Wladimir Sougakoff
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Service de Bactériologie-Hygiène, Paris, France.,Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux (CNR-MyRMA), Paris, France.,Sorbonne Université, INSERM, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Unité Mixte de Recherche (UMR) 1135, Paris, France
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9
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Baluku JB, Katuramu R, Naloka J, Kizito E, Nabwana M, Bongomin F. Multidisciplinary management of difficult-to-treat drug resistant tuberculosis: a review of cases presented to the national consilium in Uganda. BMC Pulm Med 2021; 21:220. [PMID: 34246234 PMCID: PMC8272325 DOI: 10.1186/s12890-021-01597-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/03/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Patients with drug resistant tuberculosis (DR-TB) with comorbidities and drug toxicities are difficult to treat. Guidelines recommend such patients to be managed in consultation with a multidisciplinary team of experts (the "TB consilium") to optimise treatment regimens. We describe characteristics and treatment outcomes of DR-TB cases presented to the national DR-TB consilium in Uganda between 2013 and 2019. METHODS We performed a secondary analysis of data from a nation-wide retrospective cohort of DR-TB patients with poor prognostic indicators in Uganda. Patients had a treatment outcome documented between 2013 and 2019. Characteristics and treatment outcomes were compared between cases reviewed by the consilium with those that were not reviewed. RESULTS Of 1,122 DR-TB cases, 189 (16.8%) cases from 16 treatment sites were reviewed by the consilium, of whom 86 (45.5%) were reviewed more than once. The most frequent inquiries (N = 308) from DR-TB treatment sites were construction of a treatment regimen (38.6%) and management of side effects (24.0%) while the most frequent consilium recommendations (N = 408) were a DR-TB regimen (21.7%) and "observation while on current regimen" (16.6%). Among the cases reviewed, 152 (80.4%) were from facilities other than the national referral hospital, 113 (61.1%) were aged ≥ 35 years, 72 (40.9%) were unemployed, and 26 (31.0%) had defaulted antiretroviral therapy. Additionally, 141 (90.4%) had hepatic injury, 55 (91.7%) had bilateral hearing loss, 20 (4.8%) had psychiatric symptoms and 14 (17.7%) had abnormal baseline systolic blood pressure. Resistance to second-line drugs (SLDs) was observed among 9 (4.8%) cases while 13 (6.9%) cases had previous exposure to SLDs. Bedaquiline (13.2%, n = 25), clofazimine (28.6%, n = 54), high-dose isoniazid (22.8%, n = 43) and linezolid (6.7%, n = 13) were more frequently prescribed among cases reviewed by the consilium than those not reviewed. Treatment success was observed among 126 (66.7%) cases reviewed. CONCLUSION Cases reviewed by the consilium had several comorbidities, drug toxicities and a low treatment success rate. Consilia are important "gatekeepers" for new and repurposed drugs. There is need to build capacity of lower health facilities to construct DR-TB regimens and manage adverse effects.
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Affiliation(s)
- Joseph Baruch Baluku
- Division of Pulmonology, Kiruddu National Referral Hospital, Kampala, Uganda.
- Makerere University Lung Institute, Kampala, Uganda.
| | | | | | - Enock Kizito
- USAID/Defeat TB, University Research Co LLC, Kampala, Uganda
| | - Martin Nabwana
- Makerere University - Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
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10
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Jaspard M, Butel N, El Helali N, Marigot-Outtandy D, Guillot H, Peytavin G, Veziris N, Bodaghi B, Flandre P, Petitjean G, Caumes E, Pourcher V. Linezolid-Associated Neurologic Adverse Events in Patients with Multidrug-Resistant Tuberculosis, France. Emerg Infect Dis 2020; 26:1792-1800. [PMID: 32687026 PMCID: PMC7392460 DOI: 10.3201/eid2608.191499] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Linezolid is one of the most effective drugs for treating multidrug-resistant tuberculosis (MDR TB), but adverse effects remain problematic. We evaluated 57 MDR TB patients who had received >1 dose of linezolid during 2011–2016. Overall, patients received 600 mg/day of linezolid for a median of 13 months. In 33 (58%) patients, neurologic or ophthalmologic signs developed, and 18 (32%) had confirmed peripheral neuropathy, which for 78% was irreversible at 12 months after the end of TB treatment despite linezolid withdrawal. Among the 19 patients who underwent ophthalmologic evaluation, 14 patients had optic neuropathy that fully reversed for 2. A total of 16 (33%) of 49 patients had a linezolid trough concentration >2 mg/L, and among these, 14 (88%) experienced adverse effects. No significant association was found between trough concentration and neurologic toxicity. These findings suggest the need to closely monitor patients for neurologic signs and discuss optimal duration of linezolid treatment.
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