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Multidrug-resistant tuberculosis treatment failure detection depends on monitoring interval and microbiological method
Debate persists about monitoring method (culture or smear) and interval (monthly or less frequently) during treatment for multidrug-resistant tuberculosis (MDR-TB). We analysed existing data and estimated the effect of monitoring strategies on timing of failure detection. We identified studies repor...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
European Respiratory Society
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5045442/ https://www.ncbi.nlm.nih.gov/pubmed/27587552 http://dx.doi.org/10.1183/13993003.00462-2016 |
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author | Mitnick, Carole D. White, Richard A. Lu, Chunling Rodriguez, Carly A. Bayona, Jaime Becerra, Mercedes C. Burgos, Marcos Centis, Rosella Cohen, Theodore Cox, Helen D'Ambrosio, Lia Danilovitz, Manfred Falzon, Dennis Gelmanova, Irina Y. Gler, Maria T. Grinsdale, Jennifer A. Holtz, Timothy H. Keshavjee, Salmaan Leimane, Vaira Menzies, Dick Migliori, Giovanni Battista Milstein, Meredith B. Mishustin, Sergey P. Pagano, Marcello Quelapio, Maria I. Shean, Karen Shin, Sonya S. Tolman, Arielle W. van der Walt, Martha L. Van Deun, Armand Viiklepp, Piret |
author_facet | Mitnick, Carole D. White, Richard A. Lu, Chunling Rodriguez, Carly A. Bayona, Jaime Becerra, Mercedes C. Burgos, Marcos Centis, Rosella Cohen, Theodore Cox, Helen D'Ambrosio, Lia Danilovitz, Manfred Falzon, Dennis Gelmanova, Irina Y. Gler, Maria T. Grinsdale, Jennifer A. Holtz, Timothy H. Keshavjee, Salmaan Leimane, Vaira Menzies, Dick Migliori, Giovanni Battista Milstein, Meredith B. Mishustin, Sergey P. Pagano, Marcello Quelapio, Maria I. Shean, Karen Shin, Sonya S. Tolman, Arielle W. van der Walt, Martha L. Van Deun, Armand Viiklepp, Piret |
author_sort | Mitnick, Carole D. |
collection | PubMed |
description | Debate persists about monitoring method (culture or smear) and interval (monthly or less frequently) during treatment for multidrug-resistant tuberculosis (MDR-TB). We analysed existing data and estimated the effect of monitoring strategies on timing of failure detection. We identified studies reporting microbiological response to MDR-TB treatment and solicited individual patient data from authors. Frailty survival models were used to estimate pooled relative risk of failure detection in the last 12 months of treatment; hazard of failure using monthly culture was the reference. Data were obtained for 5410 patients across 12 observational studies. During the last 12 months of treatment, failure detection occurred in a median of 3 months by monthly culture; failure detection was delayed by 2, 7, and 9 months relying on bimonthly culture, monthly smear and bimonthly smear, respectively. Risk (95% CI) of failure detection delay resulting from monthly smear relative to culture is 0.38 (0.34–0.42) for all patients and 0.33 (0.25–0.42) for HIV-co-infected patients. Failure detection is delayed by reducing the sensitivity and frequency of the monitoring method. Monthly monitoring of sputum cultures from patients receiving MDR-TB treatment is recommended. Expanded laboratory capacity is needed for high-quality culture, and for smear microscopy and rapid molecular tests. |
format | Online Article Text |
id | pubmed-5045442 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | European Respiratory Society |
record_format | MEDLINE/PubMed |
spelling | pubmed-50454422016-10-05 Multidrug-resistant tuberculosis treatment failure detection depends on monitoring interval and microbiological method Mitnick, Carole D. White, Richard A. Lu, Chunling Rodriguez, Carly A. Bayona, Jaime Becerra, Mercedes C. Burgos, Marcos Centis, Rosella Cohen, Theodore Cox, Helen D'Ambrosio, Lia Danilovitz, Manfred Falzon, Dennis Gelmanova, Irina Y. Gler, Maria T. Grinsdale, Jennifer A. Holtz, Timothy H. Keshavjee, Salmaan Leimane, Vaira Menzies, Dick Migliori, Giovanni Battista Milstein, Meredith B. Mishustin, Sergey P. Pagano, Marcello Quelapio, Maria I. Shean, Karen Shin, Sonya S. Tolman, Arielle W. van der Walt, Martha L. Van Deun, Armand Viiklepp, Piret Eur Respir J Original Articles Debate persists about monitoring method (culture or smear) and interval (monthly or less frequently) during treatment for multidrug-resistant tuberculosis (MDR-TB). We analysed existing data and estimated the effect of monitoring strategies on timing of failure detection. We identified studies reporting microbiological response to MDR-TB treatment and solicited individual patient data from authors. Frailty survival models were used to estimate pooled relative risk of failure detection in the last 12 months of treatment; hazard of failure using monthly culture was the reference. Data were obtained for 5410 patients across 12 observational studies. During the last 12 months of treatment, failure detection occurred in a median of 3 months by monthly culture; failure detection was delayed by 2, 7, and 9 months relying on bimonthly culture, monthly smear and bimonthly smear, respectively. Risk (95% CI) of failure detection delay resulting from monthly smear relative to culture is 0.38 (0.34–0.42) for all patients and 0.33 (0.25–0.42) for HIV-co-infected patients. Failure detection is delayed by reducing the sensitivity and frequency of the monitoring method. Monthly monitoring of sputum cultures from patients receiving MDR-TB treatment is recommended. Expanded laboratory capacity is needed for high-quality culture, and for smear microscopy and rapid molecular tests. European Respiratory Society 2016-10 2016-09-01 /pmc/articles/PMC5045442/ /pubmed/27587552 http://dx.doi.org/10.1183/13993003.00462-2016 Text en The content of this work is copyright the authors or their employers. Design and branding are copyright ©ERS 2016. http://creativecommons.org/licenses/by-nc/4.0/ This version is distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0. |
spellingShingle | Original Articles Mitnick, Carole D. White, Richard A. Lu, Chunling Rodriguez, Carly A. Bayona, Jaime Becerra, Mercedes C. Burgos, Marcos Centis, Rosella Cohen, Theodore Cox, Helen D'Ambrosio, Lia Danilovitz, Manfred Falzon, Dennis Gelmanova, Irina Y. Gler, Maria T. Grinsdale, Jennifer A. Holtz, Timothy H. Keshavjee, Salmaan Leimane, Vaira Menzies, Dick Migliori, Giovanni Battista Milstein, Meredith B. Mishustin, Sergey P. Pagano, Marcello Quelapio, Maria I. Shean, Karen Shin, Sonya S. Tolman, Arielle W. van der Walt, Martha L. Van Deun, Armand Viiklepp, Piret Multidrug-resistant tuberculosis treatment failure detection depends on monitoring interval and microbiological method |
title | Multidrug-resistant tuberculosis treatment failure detection depends on monitoring interval and microbiological method |
title_full | Multidrug-resistant tuberculosis treatment failure detection depends on monitoring interval and microbiological method |
title_fullStr | Multidrug-resistant tuberculosis treatment failure detection depends on monitoring interval and microbiological method |
title_full_unstemmed | Multidrug-resistant tuberculosis treatment failure detection depends on monitoring interval and microbiological method |
title_short | Multidrug-resistant tuberculosis treatment failure detection depends on monitoring interval and microbiological method |
title_sort | multidrug-resistant tuberculosis treatment failure detection depends on monitoring interval and microbiological method |
topic | Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5045442/ https://www.ncbi.nlm.nih.gov/pubmed/27587552 http://dx.doi.org/10.1183/13993003.00462-2016 |
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