BMC Infectious Diseases (Aug 2017)

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

  • D. M. P. Ramalho,
  • P. F. C. Miranda,
  • M. K. Andrade,
  • T. Brígido,
  • M. P. Dalcolmo,
  • E. Mesquita,
  • C. F. Dias,
  • A. N. Gambirasio,
  • J. Ueleres Braga,
  • A. Detjen,
  • P. P. J. Phillips,
  • I. Langley,
  • P. I. Fujiwara,
  • S. B. Squire,
  • M. M. Oliveira,
  • A. L. Kritski,
  • for Rede-TB Study group

DOI
https://doi.org/10.1186/s12879-017-2669-1
Journal volume & issue
Vol. 17, no. 1
pp. 1 – 13

Abstract

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

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