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Free Content Prevalence of pyrazinamide resistance and Wayne assay performance analysis in a tuberculosis cohort in Lima, Peru

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BACKGROUND: Multidrug-resistant tuberculosis (MDR-TB) regimens often contain pyrazinamide (PZA) even if susceptibility to the drug has not been confirmed. This gap is due to the limited availability and reliability of PZA susceptibility testing.

OBJECTIVES: To estimate the prevalence of PZA resistance using the Wayne assay among TB patients in Lima, Peru, to describe characteristics associated with PZA resistance and to compare the performance of Wayne with that of BACTEC™ MGIT™ 960.

METHODS: PZA susceptibility using the Wayne assay was tested in patients diagnosed with culture-positive pulmonary TB from September 2009 to August 2012. Factors associated with PZA resistance were evaluated. We compared the performance of the Wayne assay to that of MGIT 960 in a convenience sample.

RESULTS: The prevalence of PZA resistance was 6.6% (95%CI 5.8–7.5) among 3277 patients, and 47.7% (95%CI 42.7–52.6) among a subset of 405 MDR-TB patients. In multivariable analysis, MDR-TB (OR 86.0, 95%CI 54.0–136.9) and Latin American-Mediterranean lineage (OR 3.40, 95%CI 2.33–4.96) were associated with PZA resistance. The Wayne assay was in agreement with MGIT 960 in 83.9% of samples (κ 0.66, 95%CI 0.56–0.76).

CONCLUSION: PZA resistance was detected using the Wayne assay in nearly half of MDR-TB patients in Lima. This test can inform the selection and composition of regimens, especially those dependent on additional resistance.
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Keywords: PZA; Peru; Wayne assay; drug resistance; multidrug-resistant tuberculosis; pyrazinamidase assay

Document Type: Research Article

Affiliations: 1: Socios En Salud Sucursal Peru, Lima, Peru; Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil 2: Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA 3: Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA; Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA 4: Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA 5: Socios En Salud Sucursal Peru, Lima, Peru 6: Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil 7: Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA; Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, Massachusetts, USA

Publication date: 01 August 2017

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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