Cargando…

Decreased mortality seen in rifampicin/multidrug-resistant tuberculous meningitis treated with linezolid in Shenzhen, China

BACKGROUND: The morbidity of rifampicin/multidrug-resistant tuberculous meningitis (RR/MDR-TBM) has shown an increasing trend globally. Its mortality rate is significantly higher than that of non-rifampicin/multidrug-resistant tuberculous meningitis (NRR/MDR-TBM). This article aimed to explore risk...

Descripción completa

Detalles Bibliográficos
Autores principales: Fang, Mu-Tong, Su, You-Feng, An, Hui-Ru, Zhang, Pei-Ze, Deng, Guo-Fang, Liu, Hou-Ming, Mao, Zhi, Zeng, Jian-Feng, Li, Guobao, Yang, Qian-Ting, Wang, Zhong-Yuan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8480033/
https://www.ncbi.nlm.nih.gov/pubmed/34583653
http://dx.doi.org/10.1186/s12879-021-06705-4
_version_ 1784576388011917312
author Fang, Mu-Tong
Su, You-Feng
An, Hui-Ru
Zhang, Pei-Ze
Deng, Guo-Fang
Liu, Hou-Ming
Mao, Zhi
Zeng, Jian-Feng
Li, Guobao
Yang, Qian-Ting
Wang, Zhong-Yuan
author_facet Fang, Mu-Tong
Su, You-Feng
An, Hui-Ru
Zhang, Pei-Ze
Deng, Guo-Fang
Liu, Hou-Ming
Mao, Zhi
Zeng, Jian-Feng
Li, Guobao
Yang, Qian-Ting
Wang, Zhong-Yuan
author_sort Fang, Mu-Tong
collection PubMed
description BACKGROUND: The morbidity of rifampicin/multidrug-resistant tuberculous meningitis (RR/MDR-TBM) has shown an increasing trend globally. Its mortality rate is significantly higher than that of non-rifampicin/multidrug-resistant tuberculous meningitis (NRR/MDR-TBM). This article aimed to explore risk factors related to RR/MDR-TBM, and compare therapeutic effects of linezolid (LZD)- and non-linezolid-containing regimen for RR/MDR-TB patients in Shenzhen city. Furthermore, we aimed to find a better therapy for pathogen-negative TBM with RR/MDR-TBM related risk factors. METHODS: We conducted a retrospective study enrolling 137 hospitalized cases with confirmed TBM from June 2014 to March 2020. All patients were divided into RR/MDR-TBM group (12 cases) and NRR/MDR-TBM group (125 cases) based on GeneXpert MTB/RIF and (or) phenotypic drug susceptibility test results using cerebral spinal fluid (CSF). The risk factors related to RR/MDR-TBM were investigated through comparing clinical and examination features between the two groups. The mortality rate of RR/MDR-TBM patients treated with different regimens was analyzed to compare their respective therapeutic effects. A difference of P < 0.05 was considered statistically significant. RESULTS: Most patients (111/137, 81%) were from southern or southwestern China, and a large proportion (72/137, 52.55%) belonged to migrant workers. 12 cases were RR/MDR-TBM (12/137, 8.8%) while 125 cases were NRR/MDR-TBM (125/137, 91.2%). The proportion of patients having prior TB treatment history in the RR/MDR-TBM group was significantly higher than that of the NRR/MDR-TBM group (6/12 vs. 12/125, 50% vs. 10.5%, P < 0.01). No significant difference was observed on other clinical and examination features between the two groups. Mortality was significantly lower in RR/MDR-TBM patients on linezolid-containing treatment regimen than those who were not (0/7 versus 3/5, 0% versus 60%, P = 0.045). CONCLUSIONS: The main related risk factor of RR/MDR-TBM is the history of anti-tuberculosis treatment. Linezolid-containing regimen appears to lower mortality rate of RR/MDR-TBM significantly in our study. We think Linezolid should be evaluated prospectively in the treatment of RR/MDR-TBM.
format Online
Article
Text
id pubmed-8480033
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-84800332021-09-30 Decreased mortality seen in rifampicin/multidrug-resistant tuberculous meningitis treated with linezolid in Shenzhen, China Fang, Mu-Tong Su, You-Feng An, Hui-Ru Zhang, Pei-Ze Deng, Guo-Fang Liu, Hou-Ming Mao, Zhi Zeng, Jian-Feng Li, Guobao Yang, Qian-Ting Wang, Zhong-Yuan BMC Infect Dis Research Article BACKGROUND: The morbidity of rifampicin/multidrug-resistant tuberculous meningitis (RR/MDR-TBM) has shown an increasing trend globally. Its mortality rate is significantly higher than that of non-rifampicin/multidrug-resistant tuberculous meningitis (NRR/MDR-TBM). This article aimed to explore risk factors related to RR/MDR-TBM, and compare therapeutic effects of linezolid (LZD)- and non-linezolid-containing regimen for RR/MDR-TB patients in Shenzhen city. Furthermore, we aimed to find a better therapy for pathogen-negative TBM with RR/MDR-TBM related risk factors. METHODS: We conducted a retrospective study enrolling 137 hospitalized cases with confirmed TBM from June 2014 to March 2020. All patients were divided into RR/MDR-TBM group (12 cases) and NRR/MDR-TBM group (125 cases) based on GeneXpert MTB/RIF and (or) phenotypic drug susceptibility test results using cerebral spinal fluid (CSF). The risk factors related to RR/MDR-TBM were investigated through comparing clinical and examination features between the two groups. The mortality rate of RR/MDR-TBM patients treated with different regimens was analyzed to compare their respective therapeutic effects. A difference of P < 0.05 was considered statistically significant. RESULTS: Most patients (111/137, 81%) were from southern or southwestern China, and a large proportion (72/137, 52.55%) belonged to migrant workers. 12 cases were RR/MDR-TBM (12/137, 8.8%) while 125 cases were NRR/MDR-TBM (125/137, 91.2%). The proportion of patients having prior TB treatment history in the RR/MDR-TBM group was significantly higher than that of the NRR/MDR-TBM group (6/12 vs. 12/125, 50% vs. 10.5%, P < 0.01). No significant difference was observed on other clinical and examination features between the two groups. Mortality was significantly lower in RR/MDR-TBM patients on linezolid-containing treatment regimen than those who were not (0/7 versus 3/5, 0% versus 60%, P = 0.045). CONCLUSIONS: The main related risk factor of RR/MDR-TBM is the history of anti-tuberculosis treatment. Linezolid-containing regimen appears to lower mortality rate of RR/MDR-TBM significantly in our study. We think Linezolid should be evaluated prospectively in the treatment of RR/MDR-TBM. BioMed Central 2021-09-28 /pmc/articles/PMC8480033/ /pubmed/34583653 http://dx.doi.org/10.1186/s12879-021-06705-4 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Fang, Mu-Tong
Su, You-Feng
An, Hui-Ru
Zhang, Pei-Ze
Deng, Guo-Fang
Liu, Hou-Ming
Mao, Zhi
Zeng, Jian-Feng
Li, Guobao
Yang, Qian-Ting
Wang, Zhong-Yuan
Decreased mortality seen in rifampicin/multidrug-resistant tuberculous meningitis treated with linezolid in Shenzhen, China
title Decreased mortality seen in rifampicin/multidrug-resistant tuberculous meningitis treated with linezolid in Shenzhen, China
title_full Decreased mortality seen in rifampicin/multidrug-resistant tuberculous meningitis treated with linezolid in Shenzhen, China
title_fullStr Decreased mortality seen in rifampicin/multidrug-resistant tuberculous meningitis treated with linezolid in Shenzhen, China
title_full_unstemmed Decreased mortality seen in rifampicin/multidrug-resistant tuberculous meningitis treated with linezolid in Shenzhen, China
title_short Decreased mortality seen in rifampicin/multidrug-resistant tuberculous meningitis treated with linezolid in Shenzhen, China
title_sort decreased mortality seen in rifampicin/multidrug-resistant tuberculous meningitis treated with linezolid in shenzhen, china
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8480033/
https://www.ncbi.nlm.nih.gov/pubmed/34583653
http://dx.doi.org/10.1186/s12879-021-06705-4
work_keys_str_mv AT fangmutong decreasedmortalityseeninrifampicinmultidrugresistanttuberculousmeningitistreatedwithlinezolidinshenzhenchina
AT suyoufeng decreasedmortalityseeninrifampicinmultidrugresistanttuberculousmeningitistreatedwithlinezolidinshenzhenchina
AT anhuiru decreasedmortalityseeninrifampicinmultidrugresistanttuberculousmeningitistreatedwithlinezolidinshenzhenchina
AT zhangpeize decreasedmortalityseeninrifampicinmultidrugresistanttuberculousmeningitistreatedwithlinezolidinshenzhenchina
AT dengguofang decreasedmortalityseeninrifampicinmultidrugresistanttuberculousmeningitistreatedwithlinezolidinshenzhenchina
AT liuhouming decreasedmortalityseeninrifampicinmultidrugresistanttuberculousmeningitistreatedwithlinezolidinshenzhenchina
AT maozhi decreasedmortalityseeninrifampicinmultidrugresistanttuberculousmeningitistreatedwithlinezolidinshenzhenchina
AT zengjianfeng decreasedmortalityseeninrifampicinmultidrugresistanttuberculousmeningitistreatedwithlinezolidinshenzhenchina
AT liguobao decreasedmortalityseeninrifampicinmultidrugresistanttuberculousmeningitistreatedwithlinezolidinshenzhenchina
AT yangqianting decreasedmortalityseeninrifampicinmultidrugresistanttuberculousmeningitistreatedwithlinezolidinshenzhenchina
AT wangzhongyuan decreasedmortalityseeninrifampicinmultidrugresistanttuberculousmeningitistreatedwithlinezolidinshenzhenchina