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

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

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Title: Multidrug-resistant tuberculosis treatment failure detection depends on monitoring interval and microbiological method
Author: Mitnick, Carole D.; White, Richard A.; Lu, Chunling; Rodriguez, Carly A.; Bayona, Jaime; Becerra, Mercedes C.; Burgos, Marcos; Centis, Rosella; Cohen, Theodore; Cox, Helen; D'Ambrosio, Lia; Danilovitz, Manfred; Falzon, Dennis; Gelmanova, Irina Y.; Gler, Maria T.; Grinsdale, Jennifer A.; Holtz, Timothy H.; Keshavjee, Salmaan; Leimane, Vaira; Menzies, Dick; Migliori, Giovanni Battista; Milstein, Meredith B.; Mishustin, Sergey P.; Pagano, Marcello; Quelapio, Maria I.; Shean, Karen; Shin, Sonya S.; Tolman, Arielle W.; van der Walt, Martha L.; Van Deun, Armand; Viiklepp, Piret

Note: Order does not necessarily reflect citation order of authors.

Citation: Mitnick, C. D., R. A. White, C. Lu, C. A. Rodriguez, J. Bayona, M. C. Becerra, M. Burgos, et al. 2016. “Multidrug-resistant tuberculosis treatment failure detection depends on monitoring interval and microbiological method.” The European Respiratory Journal 48 (4): 1160-1170. doi:10.1183/13993003.00462-2016. http://dx.doi.org/10.1183/13993003.00462-2016.
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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.
Published Version: doi:10.1183/13993003.00462-2016
Other Sources: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5045442/pdf/
Terms of Use: This article is made available under the terms and conditions applicable to Other Posted Material, as set forth at http://nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of-use#LAA
Citable link to this page: http://nrs.harvard.edu/urn-3:HUL.InstRepos:29408431
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