Improving Quality of Patient Data for Treatment of Multidrug- or Rifampin-Resistant Tuberculosis

Campbell, Jonathon R.; Falzon, Dennis; Mirzayev, Fuad; Jaramillo, Ernesto; Migliori, Giovanni Battista; Mitnick, Carole D.; Ndjeka, Norbert; Menzies, Dick

doi:10.3201/eid2603.190997

Cited by 11 publications

(9 citation statements)

References 33 publications

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“…This study has in-built limitations related to its retrospective design (data quality and completeness), that may have biased some findings (Campbell et al, 2020). However, the study enabled a collaborative network between PHU and RC caring for children with TB to be implemented and a large cohort representative of high TB burden areas in the metropolitan area of Rio de Janeiro to be described.…”

Section: Discussionmentioning

confidence: 99%

Pediatric tuberculosis in the metropolitan area of Rio de Janeiro

Carvalho¹,

Martins²,

Cardoso³

et al. 2020

International Journal of Infectious Diseases

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To evaluate the clinical characteristics, diagnostic approach, and treatment outcomes of tuberculosis (TB) in children living in a high-burden metropolitan area. Methods: This was a retrospective study, based on a medical chart review, involving children under 15 years old treated for TB between 2007 and 2016, in four primary health units (PHU) and three reference centers (RC) in five cities of Rio de Janeiro metropolitan area. Factors associated with TB treatment setting, microbiological diagnosis, and treatment outcomes were evaluated. Results: A total of 544 children were enrolled; 71% were treated in PHU, 36% were under 5 years old, and 72% had pulmonary TB (PTB). The HIV prevalence was 10% (31/322). Fifty-three percent had at least one microbiological test for TB, 68% of them (196/287) had TB confirmed. Among 222 children with previous TB contact, information on LTBI was available for 78 (35%), and only 17% (13/78) were treated. Extrapulmonary TB (56% vs 32%), microbiologically confirmed TB (77% vs 60%), and HIV positivity (18.5% vs 4.0%) were significantly more frequent in RC. Treatment in RC (odds ratio (OR) 3.08, 95% confidence interval (CI) 1.74-5.44) and PTB (OR 2.47, 95% CI 1.34-4.56) were independently associated with a microbiological diagnosis of TB. The treatment success rate was 85%. In the logistic regression analysis, HIV-infected children had a 2.5-fold higher risk of an unfavorable outcome (OR 2.53, 95% CI 1.0-6.38; p = 0.05). Conclusions: Opportunities for TB prevention and early TB treatment are missed due to suboptimal close contact screening. Microbiological diagnosis of TB and drug susceptibility testing in children should be made available through more sensitive and accessible tests.

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Section: Discussionmentioning

confidence: 99%

Pediatric tuberculosis in the metropolitan area of Rio de Janeiro

Carvalho¹,

Martins²,

Cardoso³

et al. 2020

International Journal of Infectious Diseases

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“…Similarly, data on the severity of adverse events is limited due to inconsistent documentation of objective measures. The small sample size limits us to descriptive analysis with insufficient numbers for further statistical analysis, however we aimed to collect data that could be compiled with other patient-level studies [ 53 ]. Additionally, we sought to provide sufficient pragmatic program details for comparison to other low incidence countries.…”

Section: Discussionmentioning

confidence: 99%

Rifampin-resistant/multidrug-resistant Tuberculosis in Alberta, Canada: Epidemiology and treatment outcomes in a low-incidence setting

Edwards

Cooper

et al. 2021

PLoS ONE

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Treatment of rifampin-monoresistant/multidrug-resistant Tuberculosis (RR/MDR-TB) requires long treatment courses, complicated by frequent adverse events and low success rates. Incidence of RR/MDR-TB in Canada is low and treatment practices are variable due to the infrequent experience and challenges with drug access. We undertook a retrospective cohort study of all RR/MDR-TB cases in Alberta, Canada from 2007–2017 to explore the epidemiology and outcomes in our low incidence setting. We performed a descriptive analysis of the epidemiology, treatment regimens and associated outcomes, calculating differences in continuous and discrete variables using Student’s t and Chi-squared tests, respectively. We identified 24 patients with RR/MDR-TB. All patients were foreign-born with the median time to presentation after immigration being 3 years. Prior treatment was reported in 46%. Treatment was individualized. All patients achieved sputum culture conversion within two months of treatment initiation. The median treatment duration after culture conversion was 18 months (IQR: 15–19). The mean number of drugs utilized during the intensive phase was 4.3 (SD: 0.8) and during the continuation phase was 3.3 (SD: 0.9) and the mean adherence to medications was 95%. Six patients completed national guideline-concordant therapy, with many patients developing adverse events (79%). Treatment success (defined as completion of prescribed therapy or cure) was achieved in 23/24 patients and no acquired drug resistance or relapse was detected over 1.8 years of median follow-up. Many cases were captured upon immigration assessment, representing important prevention of community spread. Despite high rates of adverse events and short treatment compared to international guidelines, success in our cohort was very high at 96%. This is likely due to individualization of therapy, frequent use of medications with high effectiveness, intensive treatment support, and early sputum conversion seen in our cohort. There should be ongoing exploration of treatment shortening with well-tolerated, efficacious oral agents to help patients achieve treatment completion.

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“…Case 7 (index case) travelled from Georgia to Germany (orange line) polyneuropathy leading to discontinuation of linezolid in the adult patients or the high frequency hearing loss occurring in all patients treated with amikacin. All patients receiving an MDR-TB treatment should undergo systematic clinical and laboratory assessment to detect and allow rapid management of drug toxicity and adverse events [27,28]. Standardized data should be systematically collected and reported to inform future policies on MDR-TB treatment strategies.…”

Section: Personalized Treatment Of Patients With Mdr-tbmentioning

confidence: 99%

Multidrug-resistant Mycobacterium tuberculosis: a report of cosmopolitan microbial migration and an analysis of best management practices

et al. 2020

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Background Tuberculosis (TB) control is a primary global health priority but the goal to eliminate TB is being threatened by the increase in incidence of multidrug-resistant tuberculosis (MDR-TB). With this series of seven MDR-TB cases in migrant patients with identical Mycobacterium tuberculosis strains we aim to illustrate the challenges encountered during therapy and follow-up: language barriers, access to care for migrant patients, depression due to isolation, adverse reactions to the treatment, management of pediatric TB, further contact tracing. We also discuss best practices for the management of complex MDR-TB cases in settings with low overall TB incidence focusing on modern diagnostic assays and an individualized and an interdisciplinary therapeutic approach. Methods We describe a case series of seven consecutively diagnosed MDR-TB patients, six of them treated at our tertiary care hospital between May 2018 and March 2020. Epidemiologic data was gained by semi-structured patient interviews and reconstruction of the migration route. The origin of the cluster was confirmed by genotyping of the TB-strains. Results Six related patients were diagnosed with pulmonary MDR-TB between May and August 2018. All had a positive Interferon-Gamma-Release Assay (IGRA), in five patients sputum microscopy was positive for acid-fast bacilli (AFB). The genetic and phenotypical drug susceptibility test did not match with MDR-TB strains from an East-African origin. The index patient was identified through genetical fingerprinting. By changing the therapy to a modern MDR-TB regime and using an interdisciplinary and culture-sensitive approach, all patients improved clinically and radiologically. Conclusion Human migration plays an important role for the global spread of MDR-TB in low incidence countries. Early case detection and adequate treatment are key to prevention of outbreaks. Especially language barriers and complex migration routes make genotyping of TB-strains a crucial tool to identify cases clusters, the potential index patient and transmission dynamics. We are fortunate enough to experience times in which new TB-antibiotics were made available and in which molecular assays revolutionized TB-diagnostics. We need to take advantage of that and develop personalized therapies for patients suffering from drug resistant TB.

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Improving Quality of Patient Data for Treatment of Multidrug- or Rifampin-Resistant Tuberculosis

Cited by 11 publications

References 33 publications

Pediatric tuberculosis in the metropolitan area of Rio de Janeiro

Pediatric tuberculosis in the metropolitan area of Rio de Janeiro

Rifampin-resistant/multidrug-resistant Tuberculosis in Alberta, Canada: Epidemiology and treatment outcomes in a low-incidence setting

Multidrug-resistant Mycobacterium tuberculosis: a report of cosmopolitan microbial migration and an analysis of best management practices

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