Outcomes from patients with presumed drug resistant tuberculosis in five reference centers in Brazil
Outcomes from patients with presumed drug resistant tuberculosis in five reference centers in Brazil
Data
2017
Autores
Ramalho, D. M. P.
Miranda, P. F. C.
Andrade, M. K.
Brígido, T.
Dalcolmo, M. P.
Mesquita, E.
Dias, C. F.
Gambirasio, A. N.
Braga, J. Ueleres
Detjen, A.
Journal Title
Journal ISSN
Volume Title
Publisher
BMC Infectious Diseases
Resumo
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.
Description
Palavras-chave
Multi-drug resistant tuberculosis, Diagnosis, Treatment outcome.
Citação
Ramalho DMP, Miranda PFC, Andrade MK, Brígido T, Dalcolmo MP, Mesquita E, Dias CF, Gambirasio AN, Ueleres Braga J, Detjen A, Phillips PPJ, Langley I, Fujiwara PI, Squire SB, Oliveira MM, Kritski AL; for Rede-TB Study group. Outcomes from patients with presumed drug resistant tuberculosis in five reference centers in Brazil. BMC Infect Dis. 2017 Aug 15;17(1):571. doi: 10.1186/s12879-017-2669-1.