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Revised Definitions of Tuberculosis Resistance and Treatment Outcomes, France, 2006-2019

Yousra Kherabi et al. Emerg Infect Dis. 2022 Sep.

Abstract

Definitions of resistance in multidrug-resistant tuberculosis (MDR TB) and extensively drug-resistant tuberculosis (XDR TB) have been updated. Pre-XDR TB, defined as MDR TB with additional resistance to fluoroquinolones, and XDR TB, with additional resistance to bedaquiline or linezolid, are frequently associated with treatment failure and toxicity. We retrospectively determined the effects of pre-XDR/XDR TB resistance on outcomes and safety of MDR TB treatment in France. The study included 298 patients treated for MDR TB at 3 reference centers during 2006-2019. Of those, 205 (68.8%) cases were fluoroquinolone-susceptible MDR TB and 93 (31.2%) were pre-XDR/XDR TB. Compared with fluoroquinolone-susceptible MDR TB, pre-XDR/XDR TB was associated with more cavitary lung lesions and bilateral disease and required longer treatment. Overall, 202 patients (67.8%) had favorable treatment outcomes, with no significant difference between pre-XDR/XDR TB (67.7%) and fluoroquinolone-susceptible MDR TB (67.8%; p = 0.99). Pre-XDR/XDR TB was not associated with higher risk for serious adverse events.

Keywords: France; MDR TB; XDR TB; antimicrobial resistance; bacteria; bedaquiline; linezolid; respiratory infections; tuberculosis; tuberculosis and other mycobacteria.

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Figures

Figure
Figure
Kaplan–Meier curves of sputum time to culture conversion in fluoroquinolone-susceptible MDR TB and pre-XDR/XDR TB patients (log rank test p = 0.001). MDR, multidrug resistant (susceptible to all fluoroquinolones); pre-XDR/XDR, pre–extensively drug resistant/extensively drug resistant (resistant to >1 fluoroquinolone); TB, tuberculosis.
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