Drug-resistant tuberculosis: A disease of target populations in Houston, Texas

Sahly, Hana M. El; Teeter, Larry D.; Pawlak, R.; Musser, James M.; Graviss, Edward A.

doi:10.1016/j.jinf.2005.10.002

Cited by 19 publications

(14 citation statements)

References 29 publications

(34 reference statements)

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“…The existing level of moxifloxacin resistance is comparable to the low prevalence of MDR-TB (0.64%) in Houston (10). We found a statistically significant association between moxifloxacin resistance and MDR-TB, confirming findings from other geographic regions (5,14,15,33).…”

Section: Discussionsupporting

confidence: 86%

Incidence of Moxifloxacin Resistance in Clinical Mycobacterium tuberculosis Isolates in Houston, Texas

et al. 2011

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Comprehensive data on the prevalence of quinolone resistance in Mycobacterium tuberculosis clinical isolates in the United States are scarce. By use of a systematic population-based approach, M. tuberculosis strains from tuberculosis (TB) cases were collected in Harris County, TX, in 2007 to 2008. The susceptibilities of M. tuberculosis isolates to moxifloxacin and ofloxacin were determined by the agar proportion indirect susceptibility method. Spoligotyping and 12-locus mycobacterial interspersed repetitive unit (MIRU12)-based genotyping of M. tuberculosis isolates were performed, and the gyrA, gyrB, Rv2686c, Rv2687c, and Rv2688c genes in quinolone-resistant and year-of-diagnosis-matched M. tuberculosis isolates were sequenced. Susceptibility testing was performed on 557 M. tuberculosis isolates, of which 10 (1.8%) were resistant to moxifloxacin. There was 100% concordance between ofloxacin and moxifloxacin susceptibilities. A quinolone was prescribed to at least 5 (50%) patients in the period preceding TB diagnosis. Multidrug-resistant TB (MDR-TB) was significantly associated with quinolone resistance (P ‫؍‬ 0.01). Mutations in the quinolone resistance-determining region of gyrA were found for 50% of the resistant isolates. No other presumptive quinolone resistance-associated mutations were identified. We conclude that the incidence of moxifloxacin-resistant TB is low in Harris County and is associated with MDR-TB. Previous exposure to quinolones is common among patients with moxifloxacin resistance and warrants more careful evaluation.The antituberculosis drug pipeline is extremely slow: it has been more than 40 years since rifampin was introduced for wide clinical use. While fluoroquinolones were initially indicated and widely used for nonmycobacterial infections, their antituberculosis properties were recognized early and described in the literature (16). Their tolerability and relative low to moderate cost have made them an attractive target for development as antituberculosis drugs. The newer quinolones, such as sparfloxacin, gatifloxacin, and moxifloxacin, have better in vitro activity against Mycobacterium tuberculosis clinical isolates than older quinolones, such as ofloxacin, levofloxacin and ciprofloxacin, as suggested by lower MICs, a higher ratio of the peak serum drug concentration to the MIC, and a higher ratio of the 24-h area under the curve to the MIC (11,22,(27)(28)(29)36). In vivo studies in animal models and humans have corroborated these findings (19,34). Due in part to the side effects observed with sparfloxacin (phototoxicity) and gatifloxacin (dysglycemia), moxifloxacin has been the quinolone most favored in clinical antimycobacterial testing (4). Plans for further development of moxifloxacin as an antituberculosis agent to shorten the course of tuberculosis (TB) chemotherapy are under way, and clinicians are using the medication when there is intolerance or resistance to first-line antituberculosis agents.However, another dynamic can potentially affect the use of moxifloxacin in TB tre...

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Section: Discussionsupporting

confidence: 86%

Incidence of Moxifloxacin Resistance in Clinical Mycobacterium tuberculosis Isolates in Houston, Texas

et al. 2011

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“…ART is recommended for all patients with HIV and drug-resistant TB requiring second-line anti-TB drugs, irrespective of CD4 cell count, as early as possible (within the first 8 weeks) following initiation of anti-TB treatment (strong recommendation, ›###/ very low-quality evidence) Remarks Evidence was reviewed from 10 studies [41][42][43][44][45][46][47][48][49][50] to assess patient treatment outcomes when ART and second-line anti-TB drugs were used together. None of the data were from randomised controlled trials.…”

Section: Who Guidelines D Falzon Et Almentioning

confidence: 99%

WHO guidelines for the programmatic management of drug-resistant tuberculosis: 2011 update

Falzon

Jaramillo

Schünemann

et al. 2011

European Respiratory Journal

661

481

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The production of guidelines for the management of drug-resistant tuberculosis (TB) fits the mandate of the World Health Organization (WHO) to support countries in the reinforcement of patient care.WHO commissioned external reviews to summarise evidence on priority questions regarding casefinding, treatment regimens for multidrug-resistant TB (MDR-TB), monitoring the response to MDR-TB treatment, and models of care. A multidisciplinary expert panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to develop recommendations.The recommendations support the wider use of rapid drug susceptibility testing for isoniazid and rifampicin or rifampicin alone using molecular techniques. Monitoring by sputum culture is important for early detection of failure during treatment. Regimens lasting o20 months and containing pyrazinamide, a fluoroquinolone, a second-line injectable drug, ethionamide (or prothionamide), and either cycloserine or p-aminosalicylic acid are recommended. The guidelines promote the early use of antiretroviral agents for TB patients with HIV on second-line drug regimens. Systems that primarily employ ambulatory models of care are recommended over others based mainly on hospitalisation.Scientific and medical associations should promote the recommendations among practitioners and public health decision makers involved in MDR-TB care. Controlled trials are needed to improve the quality of existing evidence, particularly on the optimal composition and duration of MDR-TB treatment regimens.

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“…First is the possibility of exchange of resistance factors with other microorganisms, with the risk of transferring these genes to many pathogenic bacteria. Second, lactobacilli have been reported as the etiological agents in some cases of endocarditis that can be only controlled by antibiotic therapy (Salvana and Frank, 2006). Finally, the optimization of the use of probiotic lactobacilli in cases of gastrointestinal disorders requires the knowledge of their antibiotic resistance to reinforce the concomitant antibiotic therapy (Salminen et al , 1998).…”

Section: Introductionmentioning

confidence: 99%

Antibiotic resistance in lactic acid bacteria isolated from some pharmaceutical and dairy products

Gad¹,

Abdelhamid²,

Farag³

2014

Braz. J. Microbiol.

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A total of 244 lactic acid bacteria (LAB) strains were isolated from 180 dairy and pharmaceutical products that were collected from different areas in Minia governorate, Egypt. LAB were identified phenotypically on basis of morphological, physiological and biochemical characteristics. Lactobacillus isolates were further confirmed using PCR-based assay. By combination of phenotypic with molecular identification Lactobacillus spp. were found to be the dominant genus (138, 76.7%) followed by Streptococcus spp. (65, 36.1%) and Lactococcus spp. (27, 15%). Some contaminant organisms such as (Staphylococcus spp., Escherichia coli, Salmonella spp., mould and yeast) were isolated from the collected dairy samples but pharmaceutical products were free of such contaminants. Susceptibility of LAB isolates to antibiotics representing all major classes was tested by agar dilution method. Generally, LAB were highly susceptible to Beta-lactams except penicillin. Lactobacilli were resistant to vancomycin, however lactococci and streptococci proved to be very susceptible. Most strains were susceptible to tetracycline and showed a wide range of streptomycin MICs. The MICs of erythromycin and clindamycin for most of the LAB were within the normal range of susceptibility. Sixteen Lactobacillus, 8 Lactococcus and 8 Streptococcus isolates including all tetracycline and/or erythromycin resistant strains were tested for the presence of tetracycline and/or erythromycin resistant genes [tet(M) and/or erm(B)]. PCR assays shows that some resistant strains harbor tet(M) and/or erm(B) resistance genes.

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Drug-resistant tuberculosis: A disease of target populations in Houston, Texas

Cited by 19 publications

References 29 publications

Incidence of Moxifloxacin Resistance in Clinical Mycobacterium tuberculosis Isolates in Houston, Texas

Incidence of Moxifloxacin Resistance in Clinical Mycobacterium tuberculosis Isolates in Houston, Texas

WHO guidelines for the programmatic management of drug-resistant tuberculosis: 2011 update

Antibiotic resistance in lactic acid bacteria isolated from some pharmaceutical and dairy products

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