Multidrug-resistant tuberculosis treatment failure detection depends on monitoring interval and microbiological method

Collaborative Grp Anal Bacteriolog

Research output: Contribution to journalA1: Web of Science-article

Abstract

Debate persists about monitoring method (culture or smear) and interval (monthly or less frequently) during treatment for multidrug-resistant tuberculosis (MDR-TB). We analysed existing data and estimated the effect of monitoring strategies on timing of failure detection.

We identified studies reporting microbiological response to MDR-TB treatment and solicited individual patient data from authors. Frailty survival models were used to estimate pooled relative risk of failure detection in the last 12 months of treatment; hazard of failure using monthly culture was the reference.

Data were obtained for 5410 patients across 12 observational studies. During the last 12 months of treatment, failure detection occurred in a median of 3 months by monthly culture; failure detection was delayed by 2, 7, and 9 months relying on bimonthly culture, monthly smear and bimonthly smear, respectively. Risk (95% CI) of failure detection delay resulting from monthly smear relative to culture is 0.38 (0.34-0.42) for all patients and 0.33 (0.25-0.42) for HIV-co-infected patients.

Failure detection is delayed by reducing the sensitivity and frequency of the monitoring method. Monthly monitoring of sputum cultures from patients receiving MDR-TB treatment is recommended. Expanded laboratory capacity is needed for high-quality culture, and for smear microscopy and rapid molecular tests.

Original languageEnglish
JournalEuropean Respiratory Journal
Volume48
Issue number4
Pages (from-to)1160-1170
Number of pages11
ISSN0903-1936
DOIs
Publication statusPublished - 2016

Keywords

  • NEGATIVE PULMONARY TUBERCULOSIS
  • PATIENT DATA METAANALYSIS
  • TREATMENT OUTCOMES
  • INCOME COUNTRIES
  • HIV-INFECTION
  • SOUTH-AFRICA
  • IMPACT
  • COST
  • ELIMINATION
  • DEFINITION

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