Concordance of Drug-resistance Profiles Between Persons With Drug-resistant Tuberculosis and Their Household Contacts: A Systematic Review and Meta-analysis

Abstract

Background Household contacts of patients with drug-resistant tuberculosis are at high risk for being infected with Mycobacterium tuberculosis and for developing tuberculosis disease. To guide regimen composition for the empirical treatment of tuberculosis infection and disease in these household contacts, we estimated drug resistance profile concordance between index patients with drug-resistant tuberculosis and their household contacts. Methods We performed a systematic review and meta-analysis of studies published through July 24, 2018 and reported resistance profiles of drug-resistant tuberculosis index and secondary cases within their households. Using a random-effects meta-analysis, we estimated resistance profile concordance, defined as the percentage of secondary cases whose M. tuberculosis strains were resistant to the same drugs as strains from their index cases. We also estimated isoniazid/rifampin concordance, defined as whether index and secondary cases had identical susceptibilities for isoniazid and rifampin only. Results We identified 33 eligible studies, which evaluated resistance profile concordance between 484 secondary cases and their household index cases. Pooled resistance profile concordance was 54.3% (95% confidence interval [CI]: 40.7-67.6, I2=85%). Pooled isoniazid/rifampin concordance was 82.6% (95% CI: 72.3-90.9; I2=73%). Concordance estimates were similar in a sub-analysis of 16 studies from high tuberculosis-burden countries. There were insufficient data to perform a sub-analysis among pediatric secondary cases. Conclusion Household contacts of drug-resistant TB patients should receive treatment for TB infection and disease that assumes that they, too, are infected with a drug-resistant M. tuberculosis strain. Whenever possible, drug susceptibility testing should be performed for secondary cases to optimize regimen composition.

Trials underestimate the impact of preventive treatment for household contacts exposed to multidrug-resistant tuberculosis: a simulation study

“…For example, the simulated co-prevalence of active disease in households at the time of contact investigation (3·6% [IQR 3·4 – 4·9%]) is consistent with estimates ranging from 2·87% to 3·29% in previous systematic reviews 17-19 ; the prevalence of TB infection among MDR-TB contacts (69% [IQR 68 – 77%]) is consistent with the 72% prevalence observed a multi-country feasibility study for an ongoing TPT trial 2 ; and the simulated strain concordance of co-prevalent TB cases found during MDR-TB contact investigation (81% [IQR 70 – 98%] and among MDR-TB contacts developing incident TB in the two years following contact investigation (80% [IQR 78 – 83%]) is consistent with the 82·6% (72·3-90·9%) isoniazid and rifampin concordance estimated in a systematic review of secondary cases in the households of patients with drug-resistant TB. 20 Compared to related modeling analyses, our estimate that delamanid TPT prevents ∼51% of incident MDR-TB among all TPT recipients is consistent with a previously published estimate of ∼55% incidence reduction among pediatric contacts. 21 .…”

The global impact of household contact management for children on multidrug-resistant and rifampicin-resistant tuberculosis cases, deaths, and health-system costs in 2019: a modelling study

“…A proportion of co-prevalent or incident tuberculosis among household contacts was assumed to be rifampicin susceptible (ie, non-concordant), unvarying by country, and 83% concordant (based on data from Chiang and colleagues). 19 The proportion of household contacts with multidrug-resistant or rifampicin-resistant tuberculosis who also had fluoroquinolone resistance in each country was based on WHO data, using a Bayesian scheme to estimate the proportion of rifampicin-resistant tuberculosis with fluoroquinolone resistance in each country 3 ( appendix pp 3–5 ). The probability that tuberculosis in child contacts was detected and was treated without HCM was based on the country-specific and age-specific WHO case detection ratio but inflated upwards by a random value between 1 and 2, truncating at 1, 11 because notified index patients' contacts might have above-average likelihood of detection.…”

The resistance profile of M. Tuberculosis in secondary cases of tuberculosis in relation to the index case

“…Chiang SS și coaut. (2021) relatează concordanța profilului de rezistență între cazuri secundare și cazurile index ale acestora în 54,3% [10]. Parr JB, ș.a.…”