MTBDRplus results correlate with treatment outcome in previously treated tuberculosis patients
METHODS: We prospectively enrolled 298 smear-positive pulmonary TB patients who received the World Health Organization recommended initial treatment regimen or retreatment regimen. MTBDRplus was compared with conventional drug susceptibility testing and DNA sequencing for the detection of MDR-TB. Treatment responses were monitored using sputum smear, culture and chest radiography.
RESULTS: MTBDRplus successfully identified all MDR-TB and had good concordance with sequencing. MDR-TB rates were low among new patients (4/187, 2.1%), but high in previously treated patients (12/28, 42.9%); 65.2% (15/23) of previously treated cases and 17.1% (27/158) of new cases were unsuccessfully treated (P < 0.001). Seven of eight (87.5%) previously treated MDR-TB patients failed the retreatment regimen. In addition to drug resistance, sputum smear positivity at week 8 and cavitation are associated with treatment failure.
CONCLUSION: Not only did MTBDRplus correctly identify all MDR-TB cases, MTBDRplus results are also associated with treatment outcomes in previously treated patients. The retreatment regimen should no longer be used; treatment should be guided by molecular testing.
Document Type: Research Article
Affiliations: 1: *Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai 2: †Department of Infectious Diseases, Zhuji People's Hospital, Zhejiang, China 3: ‡Center for TB Research, School of Medicine, Johns Hopkins University, Baltimore 4: *Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, §Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA 5: *Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, ¶Institutes of Biomedical Sciences, Fudan University, Shanghai, China
Publication date: 01 March 2015
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