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Observational Study
. 2017 Aug 15;17(1):571.
doi: 10.1186/s12879-017-2669-1.

Outcomes from patients with presumed drug resistant tuberculosis in five reference centers in Brazil

D M P Ramalho  1 , P F C Miranda  1 , M K Andrade  1   2 , T Brígido  3 , M P Dalcolmo  2 , E Mesquita  4 , C F Dias  5 , A N Gambirasio  6 , J Ueleres Braga  2 , A Detjen  7 , P P J Phillips  8 , I Langley  9 , P I Fujiwara  7 , S B Squire  9 , M M Oliveira  1 , A L Kritski  10 ; for Rede-TB Study group
Affiliations
Observational Study

Outcomes from patients with presumed drug resistant tuberculosis in five reference centers in Brazil

D M P Ramalho et al. BMC Infect Dis. .

Abstract

Background: The implementation of rapid drug susceptibility testing (DST) is a current global priority for TB control. However, data are scarce on patient-relevant outcomes for presumptive diagnosis of drug-resistant tuberculosis (pDR-TB) evaluated under field conditions in high burden countries.

Methods: Observational study of pDR-TB patients referred by primary and secondary health units. TB reference centers addressing DR-TB in five cities in Brazil. Patients age 18 years and older were eligible if pDR-TB, culture positive results for Mycobacterium tuberculosis and, if no prior DST results from another laboratory were used by a physician to start anti-TB treatment. The outcome measures were median time from triage to initiating appropriate anti-TB treatment, empirical treatment and, the treatment outcomes.

Results: Between February,16th, 2011 and February, 15th, 2012, among 175 pDR TB cases, 110 (63.0%) confirmed TB cases with DST results were enrolled. Among study participants, 72 (65.5%) were male and 62 (56.4%) aged 26 to 45 years. At triage, empirical treatment was given to 106 (96.0%) subjects. Among those, 85 were treated with first line drugs and 21 with second line. Median time for DST results was 69.5 [interquartile - IQR: 35.7-111.0] days and, for initiating appropriate anti-TB treatment, the median time was 1.0 (IQR: 0-41.2) days. Among 95 patients that were followed-up during the first 6 month period, 24 (25.3%; IC: 17.5%-34.9%) changed or initiated the treatment after DST results: 16/29 MDRTB, 5/21 DR-TB and 3/45 DS-TB cases. Comparing the treatment outcome to DS-TB cases, MDRTB had higher proportions changing or initiating treatment after DST results (p = 0.01) and favorable outcomes (p = 0.07).

Conclusions: This study shows a high rate of empirical treatment and long delay for DST results. Strategies to speed up the detection and early treatment of drug resistant TB should be prioritized.

Keywords: Diagnosis; Multi-drug resistant tuberculosis; Treatment outcome.

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Conflict of interest statement

Ethics approval and consent to participate

The protocol was approved by the National Research Ethics Committee (CONEP N° 520/2011; Register: 16,571 – Process: n° 25,000.115789/2011–94) and by the Ethics Advisory Group at The Union, number: 11/11. The protocol was also approved by each appropriate local Institutional Review Board and Ethics Committee.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow diagram for Baseline Prove IT/5 sites 2011–2012. Amongst the 175 pacientes, 110 were included in the study, being 51(46%) drug resistant and. Of these, 31(61%) are multi drug resistant.
See this image and copyright information in PMC

References

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