Multidrug-resistant tuberculosis around the world: what progress has been made?

Abstract

Multidrug-resistant tuberculosis (MDR-TB) (resistance to at least isoniazid and rifampicin) will influence the future of global TB control. 88% of estimated MDR-TB cases occur in middle- or high-income countries, and 60% occur in Brazil, China, India, the Russian Federation and South Africa.The World Health Organization collects country data annually to monitor the response to MDR-TB. Notification, treatment enrolment and outcome data were summarised for 30 countries, accounting for >90% of the estimated MDR-TB cases among notified TB cases worldwide.In 2012, a median of 14% (interquartile range 6–50%) of estimated MDR-TB cases were notified in the 30 countries studied. In 15 of the 30 countries, the number of patients treated for MDR-TB in 2012 (71 681) was >50% higher than in 2011. Median treatment success was 53% (interquartile range 40–70%) in the 25 countries reporting data for 30 021 MDR-TB cases who started treatment in 2010.Although progress has been noted in the expansion of MDR-TB care, urgent efforts are required in order to provide wider access to diagnosis and treatment in most countries with the highest burden of MDR-TB.

Survival of patients with multidrug-resistant TB in Eastern Europe: what makes a difference?

“…Achieving successful treatment outcome in patients with MDR-TB and in particular XDR-TB remains a challenge and death is common 12 13. Several studies looked at the factors associated with mortality in cohorts of patients with drug-susceptible and drug-resistant TB in the past 5 14–19.…”

Anti-vascular endothelial growth factor treatment normalizes tuberculosis granuloma vasculature and improves small molecule delivery

“…Although current treatment regimens are largely successful in curing the disease (2), they require 6-8 mo of treatment with up to four agents (3), and multidrug-resistant bacterial strains have emerged and proliferated (4). Resistance to front-line therapies necessitates treatment with up to five or six second-line agents that are poorly tolerated, and treatment success is only achieved in 40-70% of patients (5). Failure to cure drug-resistant disease leads to acquisition of further resistance with a progressively poorer prognosis for these patients, thus fueling an emerging epidemic of drug-resistant disease that threatens to overwhelm fragile health care systems in developing countries (6).…”

Implementation of the Xpert MTB / Rif Assay in the Kyrgyz Republic, Results, Lessons, Future Prospective

“…В проведенном исследовании, в лаборатории, где проводиться Xpert MTB/RIF и традиционные методы выявления ТБ доставляются разные пробы патологического материла, что может также приводит к несовпадению результатов, общая доля которых составила менее 10% (110/1070). О случаях "ложной" резистентности к РИФ, каковые мы наблюдали в нашем исследовании, также сообщалось в ряде исследований [16,17,18,19]. Также нами выявлено, что 32,7% (36/110) образцов, которые показали, различные результаты были доставлены в лаборатории с задержкой в 4-10 дней.…”