Transmission is a Noticeable Cause of Resistance Among Treated Tuberculosis Patients in Shanghai, China

Nsofor, Chijioke A.; Jing, Qi; Wu, Jie; Gan, Mingyu; Liu, Qingyun; Zuo, Tianyu; Zhu, Guofeng; Gao, Qian

doi:10.1038/s41598-017-08061-3

Cited by 17 publications

(19 citation statements)

References 35 publications

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“…This decline may be due to the improvement of TB treatment and management in Hangzhou City, as it has implemented the DOTS Plus program—a DOTS program with components for MDR TB diagnosis, management, and treatment. A recent study in Shanghai showed the primary resistance due to exogenous reinfection was the major cause of drug resistance among treated TB patients [ 16 ], and this observation was also confirmed in other parts of China [ 17 ]. Another study found that 60% MRD patients had primary drug resistance attributable to transmission [ 18 ].…”

Section: Discussionmentioning

confidence: 78%

Prevalence and patterns of drug resistance among pulmonary tuberculosis patients in Hangzhou, China

Zhao

et al. 2018

Antimicrob Resist Infect Control

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BackgroundTo evaluate prevalence and patterns of drug resistance among pulmonary tuberculosis (TB) patients in Hangzhou City, China.MethodsSputum samples of smear positive TB patients enrolled in 2011 and 2015 were collected and tested for drug susceptibility, and demographic and medical record data were extracted from the electronic database of China Information System for Disease Control and Prevention. Chi-square test was used to compare drug resistance prevalence between new and treated patients and between male and female patients, and Chi-square test for trend was used to compare the prevalence over calendar years 2011 and 2015.ResultsOf 1326 patients enrolled in 2015, 22.3% had resistance to any first-line anti-TB drugs and 8.0% had multi-drug resistance (MDR); drug resistance rates among previously treated cases were significantly higher than among new cases. Significant declines of resistance to isoniazid, rifampin, ethambutol and streptomycin, and MDR from 2011 to 2015 were observed among previously treated patients, while a significant decline of resistance to rifampin was observed among new cases.ConclusionsWhile the prevalence of acquired drug resistance decreased due to due to implementation of DOTS-Plus program, the prevalence of primary drug resistance due to transmission remained high. Greater efforts should be made to screen drug resistance for case finding and to reduce transmission through improving the treatment and management of drug-resistant patients.

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Section: Discussionmentioning

confidence: 78%

Prevalence and patterns of drug resistance among pulmonary tuberculosis patients in Hangzhou, China

Zhao

et al. 2018

Antimicrob Resist Infect Control

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“…Studies reported stepwise acquisition of resistance to INH and RIF (i.e., multidrug resistance [MDR]) over a period of 12 to 13 months (20,21) and increases of resistance from para-aminosalicylic acid (PAS) monoresistance to XDR within 42 months (22) and from full susceptibility or MDR to XDR within 12 to 60 months (23,24). Two other studies also reported drug resistance levels increasing from susceptible to MDR and from MDR to XDR, respectively, but without indicating the exact time lapse (25,26). In the remaining 31 studies, no increase or a one-step increase in drug resistance level was observed during treatment.…”

Section: Within-host Evolution Of Drug Resistancementioning

confidence: 99%

“…While there are likely many compensatory mechanisms, maybe as many as there are drug resistanceconferring mutations, our understanding of compensatory mutations in M. tuberculosis remains limited to the rpoC/rpoA and ahpC promoter mutations (47,85,86). As MDR-TB and XDR-TB are mainly transmitted rather than acquired (26,87,88), large data sets from MDR strains evolving to pre-XDR and XDR within a patient are difficult to obtain. Yet studies of serial isolates would provide stronger evidence of causality than mere association studies, as the chronology of events can be studied, and compensatory mutations can be distinguished from hitchhiking ones.…”

Section: Knowledge Gapsmentioning

confidence: 99%

Deciphering Within-Host Microevolution of Mycobacterium tuberculosis through Whole-Genome Sequencing: the Phenotypic Impact and Way Forward

Ley

Vos

Rie

et al. 2019

Microbiol Mol Biol Rev

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SUMMARY The Mycobacterium tuberculosis genome is more heterogenous and less genetically stable within the host than previously thought. Currently, only limited data exist on the within-host microevolution, diversity, and genetic stability of M. tuberculosis. As a direct consequence, our ability to infer M. tuberculosis transmission chains and to understand the full complexity of drug resistance profiles in individual patients is limited. Furthermore, apart from the acquisition of certain drug resistance-conferring mutations, our knowledge on the function of genetic variants that emerge within a host and their phenotypic impact remains scarce. We performed a systematic literature review of whole-genome sequencing studies of serial and parallel isolates to summarize the knowledge on genetic diversity and within-host microevolution of M. tuberculosis. We identified genomic loci of within-host emerged variants found across multiple studies and determined their functional relevance. We discuss important remaining knowledge gaps and finally make suggestions on the way forward.

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“…As a result, MDR-TB has become a major focus for TB research in recent years [ 1 , 2 ], with 480,000 new MDR-TB cases recorded in 2015 [ 1 ], comprising 5% of the total global TB burden [ 5 ]. Current evidence suggests that MDR-TB will increase globally as a proportion of total TB cases, not only due to transmission of MDR-TB [ 6 , 7 ], but also poor adherence to TB treatment leading to the emergence of MDR-TB [ 1 , 8 – 11 ]. World Health Organization (WHO) global targets for MDR-TB treatment success and adherence are currently 75%, which is lower than the 85% target for drug-sensitive TB [ 1 , 12 ], reflecting both the higher rates of mortality and barriers to treatment adherence.…”

Section: Introductionmentioning

confidence: 99%

Multidrug-resistant tuberculosis treatment adherence in migrants: a systematic review and meta-analysis

Nellums

Rustage

Hargreaves

et al. 2018

BMC Med

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BackgroundMultidrug-resistant tuberculosis (MDR-TB) is a growing concern in meeting global targets for TB control. In high-income low-TB-incidence countries, a disproportionate number of MDR-TB cases occur in migrant (foreign-born) populations, with concerns about low adherence rates in these patients compared to the host non-migrant population. Tackling MDR-TB in this context may, therefore, require unique approaches. We conducted a systematic review and meta-analysis to identify and synthesise data on MDR-TB treatment adherence in migrant patients to inform evidence-based strategies to improve care pathways and health outcomes in this group.MethodsThis systematic review and meta-analysis was conducted in line with PRISMA guidelines (PROSPERO 42017070756). The databases Embase, MEDLINE, Global Health and PubMed were searched to 24 May 2017 for primary research reporting MDR-TB treatment adherence and outcomes in migrant populations, with no restrictions on dates or language. A meta-analysis was conducted using random-effects models.ResultsFrom 413 papers identified in the database search, 15 studies reporting on MDR-TB treatment outcomes for 258 migrants and 174 non-migrants were included in the systematic review and meta-analysis. The estimated rate of adherence to MDR-TB treatment across migrant patients was 71% [95% confidence interval (CI) = 58–84%], with non-adherence reported among 20% (95% CI = 4–37%) of migrant patients. A key finding was that there were no differences in estimated rates of adherence [risk ratio (RR) = 1.05; 95% CI = 0.82–1.34] or non-adherence (RR = 0.97; 95% CI = 0.79–1.36) between migrants and non-migrants.ConclusionsMDR-TB treatment adherence rates among migrants in high-income low-TB-incidence countries are approaching global targets for treatment success (75%), and are comparable to rates in non-migrants. The findings highlight that only just over 70% of migrant and non-migrant patients adhere to MDR-TB treatment. The results point to the importance of increasing adherence in all patient groups, including migrants, with an emphasis on tailoring care based on social risk factors for poor adherence. We believe that MDR-TB treatment targets are not ambitious enough.

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Transmission is a Noticeable Cause of Resistance Among Treated Tuberculosis Patients in Shanghai, China

Cited by 17 publications

References 35 publications

Prevalence and patterns of drug resistance among pulmonary tuberculosis patients in Hangzhou, China

Prevalence and patterns of drug resistance among pulmonary tuberculosis patients in Hangzhou, China

Deciphering Within-Host Microevolution of Mycobacterium tuberculosis through Whole-Genome Sequencing: the Phenotypic Impact and Way Forward

Multidrug-resistant tuberculosis treatment adherence in migrants: a systematic review and meta-analysis

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