Outcomes of pulmonary tuberculosis in patients with discordant phenotypic isoniazid resistance testing

Kim, Sukyeon; Lee, Hyun; Jeon, Kyeongman; Huh, Hee Jae; Lee, Nam Yong; Jeong, Byeong‐Ho

doi:10.1016/j.rmed.2017.11.004

Cited by 5 publications

(5 citation statements)

References 23 publications

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“…Results suggested that in patients with RIF sensitive Mtb , modifications of treatment regimens based on DST results from liquid medium could improve treatment outcomes. It was concluded that in this particular population, unfavorable outcomes may be reduced by treating for INH resistance [43] .…”

Section: Discussionmentioning

confidence: 97%

“…In this study, 94 patients with INH resistant, RIF sensitive detected by MGIT DST had 4 rpoB mutations, Leu511Pro/Met515Ile, His526Asn/Ala532Val, Asp516Tyr and His526Leu [42] .Three of the four patients with mutations were treatment failures and the other was unknown [42] . In a study that evaluated INH, Kim et al showed that 4.8% of discordant INH results between liquid and solid media existed, with majority of RIF sensitive Mtb demonstrating INH resistance in liquid medium and INH sensitivity on solid medium [43] . Results suggested that in patients with RIF sensitive Mtb , modifications of treatment regimens based on DST results from liquid medium could improve treatment outcomes.…”

Section: Discussionmentioning

confidence: 99%

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Discordant line probe genotypic testing vs culture-based drug susceptibility phenotypic testing in TB endemic KwaZulu-Natal: Impact on bedside clinical decision making

Mahomed

Mlisana

Cele

et al. 2020

Journal of Clinical Tuberculosis and Other Mycobacterial Diseas

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The recommendations for Mycobacterium tuberculosis drug susceptibility testing include both phenotypic and genotypic methods. This concurrent use of differing testing platforms has created an emerging challenge of discordant results, creating a diagnostic dilemma for the laboratorians as well as attending clinicians. We undertook a retrospective study to determine the prevalence of discordant results between the MTBDR plus line probe assay and solid culture-based drug susceptibility testing for rifampicin and isoniazid. The analysis was conducted for the period January 2013 and December 2015 at the Inkosi Albert Luthuli Central Hospital. Rifampicin and isoniazid resistance testing data were “paired” on 8273 isolates for culture-based drug susceptibility testing and line probe assay. The latter method showed high sensitivity and specificity of 93% and 95% respectively for isoniazid testing. For rifampicin testing, sensitivity and specificity were 95% and 75%. Overall, discordance was 14.6% for rifampicin and 7.2% for isoniazid. This report is not intended to determine superiority of one method over another. It is merely to show that discordance does exist between different methods of testing. Given the burden of HIV and Tuberculosis in Sub-Saharan Africa, these findings have clinical significance and huge public health implications. Clinicians should understand the limitations of phenotypic testing methods.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Discordant line probe genotypic testing vs culture-based drug susceptibility phenotypic testing in TB endemic KwaZulu-Natal: Impact on bedside clinical decision making

Mahomed

Mlisana

Cele

et al. 2020

Journal of Clinical Tuberculosis and Other Mycobacterial Diseas

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“…The former group had a more smear-positive rate and was treated by discontinuing Pyrazinamide with or without Ethambutol. However, the sample size was too small (86 TB patients), and these unfavorable outcomes were not bacteriologically confirmed, and it was impossible to validate the diagnosis as it was a retrospective analysis ( 58 ).…”

Section: Discussionmentioning

confidence: 99%

Effectiveness and safety of Levofloxacin containing regimen in the treatment of Isoniazid mono-resistant pulmonary Tuberculosis: a systematic review

et al. 2023

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BackgroundWe aimed to determine the effectiveness and safety of the Levofloxacin-containing regimen that the World Health Organization is currently recommending for the treatment of Isoniazid mono-resistant pulmonary Tuberculosis.MethodsOur eligible criteria for the studies to be included were; randomized controlled trials or cohort studies that focused on adults with Isoniazid mono-resistant tuberculosis (HrTB) and treated with a Levofloxacin-containing regimen along with first-line anti-tubercular drugs; they should have had a control group treated with first-line without Levofloxacin; should have reported treatment success rate, mortality, recurrence, progression to multidrug-resistant Tuberculosis. We performed the search in MEDLINE, EMBASE, Epistemonikos, Google Scholar, and Clinical trials registry. Two authors independently screened the titles/abstracts and full texts that were retained after the initial screening, and a third author resolved disagreements.ResultsOur search found 4,813 records after excluding duplicates. We excluded 4,768 records after screening the titles and abstracts, retaining 44 records. Subsequently, 36 articles were excluded after the full-text screening, and eight appeared to have partially fulfilled the inclusion criteria. We contacted the respective authors, and none responded positively. Hence, no articles were included in the meta-analysis.ConclusionWe found no “quality” evidence currently on the effectiveness and safety of Levofloxacin in treating HrTB.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022290333, identifier: CRD42022290333.

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“…The documented imperfect agreement between genotypic and phenotypic DST results also makes the choice of a tiebreaker limited and interpretation of the clinical implication of the reported discordance more challenging [ 14 ]. A recent study documented a reduction in unfavorable outcomes among rifampicin susceptible patients by treating, as isoniazid resistant, patients who had isoniazid susceptible results on solid media but with isoniazid-resistant results on liquid media [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Agreement of Middle brook 7H10 with Lowenstein Jensen and accuracy of the Sensititre MYCOTB plate using either method as a reference standard for Mycobacterium tuberculosis first line drug susceptibility testing

et al. 2018

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IntroductionAlthough Sensititre Mycobacterium tuberculosis (MYCOTB) plate offers both drug susceptibility testing (DST) and minimum inhibitory concentration (MIC) results, it has not been evaluated against both Lowenstein Jensen (LJ) and Middlebrook 7H10 (MB7H10) DST methods at standard critical concentrations.Materials and methodsWe analyzed 76 M. tuberculosis isolates consisting of 54 isolates from the Uganda National TB drug resistance survey done December 2009–February 2011 and 22 isolates from the World Health Organization External Quality Assessment panel for the year 2011. All isolates were tested for LJ, MB7H10 and MYCOTB plate based DSTs for streptomycin, isoniazid, rifampicin and ethambutol anti-tuberculosis drugs. The agreement of MB7H10 with LJ and accuracy of MYCOTB plate using either LJ-DST or MB7H10 as a reference standard were determined.ResultsThe agreement (kappa) of MB7H10 with LJ was; 0.687 for rifampicin, 0.498 for isoniazid, 0.275 for streptomycin and 0.082 for ethambutol which as almost similar when compared with MYCOTB plate. The sensitivity (95% confidence interval; CI) of MYCOTB plate when LJ was used as a reference standard was higher for streptomycin 87.5% (81.6–98.4) followed by isoniazid 75.9% (65.1–95.6) and rifampicin 73.1% (52.2–88.4). When MB7H10 was used as reference standard, the sensitivity of MYCOTB plate improved significantly; isoniazid 96.2% (80.3–99.9), rifampicin 94.0 (83.4–98.7) and 93.8% (69.7–99.8). There was good agreement between MYCOTB plate and MB7H10; 1.00 for ethambutol, 0.959 for streptomycin, 0.915 for rifampicin and 0.778 for isoniazid.ConclusionsThe performance of the two culture-based reference standards for phenotypic first-line drug susceptibility testing methods, LJ and MB7H10, varied much even with acceptable MYCOTB plate MICs. There was acceptable agreement and accuracy of MYCOTB plate for drug susceptibility testing when MB7H10 was used as reference standard than with LJ-DST. Results from MIC information makes the MYCOTB plate more suitable for guiding clinicians on the choice of the most appropriate TB treatment regimen as well as limits of detection for TB drug resistance.

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Outcomes of pulmonary tuberculosis in patients with discordant phenotypic isoniazid resistance testing

Cited by 5 publications

References 23 publications

Discordant line probe genotypic testing vs culture-based drug susceptibility phenotypic testing in TB endemic KwaZulu-Natal: Impact on bedside clinical decision making

Discordant line probe genotypic testing vs culture-based drug susceptibility phenotypic testing in TB endemic KwaZulu-Natal: Impact on bedside clinical decision making

Effectiveness and safety of Levofloxacin containing regimen in the treatment of Isoniazid mono-resistant pulmonary Tuberculosis: a systematic review

Agreement of Middle brook 7H10 with Lowenstein Jensen and accuracy of the Sensititre MYCOTB plate using either method as a reference standard for Mycobacterium tuberculosis first line drug susceptibility testing

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