Treatment responses in multidrug-resistant tuberculosis in Germany
OBJECTIVE: To ascertain whether differences remain in treatment responses between patients with M/XDR-TB and those with non-M/XDR-TB.
METHOD: Patients with TB were prospectively enrolled between March 2013 and March 2016 at five hospitals in Germany. Treatment was conducted following current guidelines and individualised on the basis of drug susceptibility testing. Two-month and 6-month sputum smear and sputum culture conversion rates were assessed. A clinical and radiological score were used to assess response to anti-tuberculosis treatment.
RESULTS: Non-M/XDR-TB (n = 29) and M/XDR-TB (n = 46) patients showed similar rates of microbiological conversion: 2-month smear conversion rate, 90% vs. 78%; culture conversion rate, 67% vs. 61%; time to smear conversion, 19 days (IQR 10–32) vs. 31 days (IQR 14–56) (P = 0.066); time to culture conversion, 39 days (IQR 17–67) vs. 39 days (IQR 6–85) (P = 0.191). Both clinical and radiological scores decreased after the introduction of anti-tuberculosis treatment.
CONCLUSION: There were no significant differences in scores between the two groups until 6 months of treatment. Under optimal clinical conditions, with the availability of novel diagnostics and a wide range of therapeutic options for individualised treatment, patients with M/XDR-TB achieved 6-month culture conversion rates that were compatible with those in patients with non-M/XDR-TB.
Keywords: MDR-TB; XDR-TB; culture conversion; smear conversion; tuberculosis
Document Type: Research Article
Affiliations: 1: Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, German Center for Infection Research (DZIF), Brunswick, International Health/Infectious Diseases, University of Lübeck, Lübeck, Germany 2: Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands 3: Asklepios Fachkliniken München-Gauting, Munich 4: Karl-Hansen-Klinik, Bad Lippspringe, Germany 5: Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, German Center for Infection Research (DZIF), Brunswick, International Health/Infectious Diseases, University of Lübeck, Lübeck, Germany, Department of Medicine, University of Namibia School of Medicine, Windhoek, Namibia 6: Sankt Katharinen-Krankenhaus, Frankfurt 7: Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, German Center for Infection Research (DZIF), Brunswick 8: German Center for Infection Research (DZIF), Brunswick, Sections of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Clinical Research Unit, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg 9: Thoraxklinik-Heidelberg, Heidelberg, Germany 10: Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, German Center for Infection Research (DZIF), Brunswick, International Health/Infectious Diseases, University of Lübeck, Lübeck, Germany, Department of Medicine, Karolinska Institute, Stockholm, Sweden
Publication date: 01 April 2018
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