Acquired drug resistance during the turnaround time for drug susceptibility testing impacts outcome of tuberculosis - 29/05/23
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.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Prospective cohort study of acquired drug resistance (ADR) during tuberculosis (TB) treatment. |
• | High rates of ADR during TB treatment were seen (33.9%, 65/192). |
• | ADR to pyrazinamide and isoniazid associated with worse clinical progress and outcome. |
• | Regular monitoring with drug susceptibility testing during TB treatment needed. |
Keywords : Acquired drug resistance, Phenotypic drug-susceptibility testing, First-line drugs, Turnaround time, Sputum culture conversion, Treatment failure
Abbreviations : TB, MDR, DST, TAT, RIF, INH, PZA, EMB, Mtb
Plan
Vol 140
Article 102341- mai 2023 Retour au numéro
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