Clinical mismanagement and other factors producing antituberculosis drug resistance

Pablos-Méndez, Ariel; Lessnau, Klaus

doi:10.1007/978-94-011-4084-3_5

Cited by 14 publications

(13 citation statements)

References 63 publications

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“…43 Since a history of TB may be more actively sought in those with known resistance, this can lead to differential misclassification. 13 20 31 43 Even in prospective surveys, previous TB is likely to be denied by older patients or illegal immigrants. 26 32 34 35 A patient could have already been infected with a multidrug resistant strain of M tuberculosis at the time of previous treatment, and/or a re-infection with a resistant strain may have occurred independent of the first episode of TB.…”

Section: Effect Of Treatmentmentioning

confidence: 99%

“…11 12 The selection of single drug resistant strains of Mycobacterium tuberculosis is attributable only to inadequate treatment since alternative mechanisms such as the presence of plasmids or other genetic elements has never been demonstrated for TB. 13 Unsuccessful treatment therefore plays a double role with respect to MDR-TB-it can be either a result of, or a risk factor for, MDR-TB. These relationships are so widely recognised that MDR-TB is classified as being due to previous treatment if the patient has been treated before, and attributed to an infection with an MDR strain of M tuberculosis if detected in newly diagnosed patients.…”

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confidence: 99%

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Risk factors for multidrug resistant tuberculosis in Europe: a systematic review

Faustini¹

2006

Thorax

386

265

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Background: The resurgence of tuberculosis (TB) in western countries has been attributed to the HIV epidemic, immigration, and drug resistance. Multidrug resistant tuberculosis (MDR-TB) is caused by the transmission of multidrug resistant Mycobacterium tuberculosis strains in new cases, or by the selection of single drug resistant strains induced by previous treatment. The aim of this report is to determine risk factors for MDR-TB in Europe. Methods: A systematic review was conducted of published reports of risk factors associated with MDR-TB in Europe. Meta-analysis, meta-regression, and sub-grouping were used to pool risk estimates of MDR-TB and to analyse associations with age, sex, immigrant status, HIV status, occurrence year, study design, and area of Europe. Results: Twenty nine papers were eligible for the review from 123 identified in the search. The pooled risk of MDR-TB was 10.23 times higher in previously treated than in never treated cases, with wide heterogeneity between studies. Study design and geographical area were associated with MDR-TB risk estimates in previously treated patients; the risk estimates were higher in cohort studies carried out in western Europe (RR 12.63; 95% CI 8.20 to 19.45) than in eastern Europe (RR 8.53; 95% CI 6.57 to 11.06). National estimates were possible for six countries. MDR-TB cases were more likely to be foreign born (odds ratio (OR) 2.46; 95% CI 1.86 to 3.24), younger than 65 years (OR 2.53; 95% CI 1.74 to 4.83), male (OR 1.38; 95% CI 1.16 to 1.65), and HIV positive (OR 3.52; 95% CI 2.48 to 5.01). Conclusions: Previous treatment was the strongest determinant of MDR-TB in Europe. Detailed study of the reasons for inadequate treatment could improve control strategies. The risk of MDR-TB in foreign born people needs to be re-evaluated, taking into account any previous treatment.

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Section: Effect Of Treatmentmentioning

confidence: 99%

mentioning

confidence: 99%

Risk factors for multidrug resistant tuberculosis in Europe: a systematic review

Faustini¹

2006

Thorax

386

265

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“…previously treated patients are more likely to have had or acquired multidrug resistance to Mycobacterium tuberculosis [35].…”

Section: Successful Tuberculosis Treatment Outcomesmentioning

confidence: 99%

Tuberculosis treatment outcomes in Europe: a systematic review

Faustini¹,

Hall²,

Perucci³

2005

Eur Respir J

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In order to facilitate the control of tuberculosis (TB), the World Health Organization (WHO) has defined a standardised short-course chemotherapy and a strategy, directly observed therapy. In 2000, WHO surveillance of TB treatments in Europe recorded a successful outcome rate of 77%. The aim of this report is to estimate treatment outcomes in European countries based on published studies and to identify their determinants.A systematic review was conducted of published reports of TB treatment outcomes in Europe. Meta-analysis, meta-regression and subgrouping were used to pool treatment outcomes and analyse associations with mean age, sex, immigration status and multidrug resistance.Of the 197 articles identified in the search, 26 were eligible for the review; 74.4% of outcomes were successful, 12.3% were unsuccessful and 6.8% of patients died. Heterogeneity was high for all outcomes. National estimates were possible for six countries. Multidrug resistance was inversely associated with successful outcome, which were fewer in populations with .9% multidrug-resistant TB, and in patients aged ,44 yrs.Successful tuberculosis treatment outcomes were below the 85% threshold suggested by the World Health Organization. There was an inverse association with levels of multidrug-resistant tuberculosis. The unexplained heterogeneity between the studies for unsuccessful outcomes seems to be due to differing interpretations given to World Health Organization definitions.

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“…The term "resistant strains" refers to those strains that differ from the sensitive strains in their capacity to grow in the presence of a higher concentration of a drug (42,43). MDR-TB has been documented in nearly 90 countries and regions worldwide (54) In its first two reports, the project has provided a better understanding of the magnitude and distribution of anti-TB drugs resistance and has led to policy development for the treatment of MDR-TB (2,18,33,50,51).…”

Section: Incidence and Prevalencementioning

confidence: 99%