Clinical Management of Multidrug-Resistant Tuberculosis in 16 European Countries
Language English Country United States Media print
Document type Journal Article, Research Support, Non-U.S. Gov't
- Keywords
- MDR-TB, TBNET, extensively drug-resistant TB, management, outcome definitions,
- MeSH
- Antitubercular Agents therapeutic use MeSH
- Incidence MeSH
- Cohort Studies MeSH
- Humans MeSH
- Tuberculosis, Multidrug-Resistant drug therapy epidemiology MeSH
- Prospective Studies MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Geographicals
- Europe epidemiology MeSH
- Names of Substances
- Antitubercular Agents MeSH
RATIONALE: Multidrug-resistant tuberculosis (MDR-TB) is a major burden to public health in Europe. Reported treatment success rates are around 50% or less, and cure rates are even lower. OBJECTIVES: To document the management and treatment outcome in patients with MDR-TB in Europe. METHODS: We performed a prospective cohort study, analyzing management and treatment outcomes stratified by incidence of patients with MDR-TB in Europe. Treatment outcomes were compared by World Health Organization and alternative simplified definitions by the Tuberculosis Network European Trialsgroup (TBNET). MEASUREMENTS AND MAIN RESULTS: A total of 380 patients with MDR-TB were recruited and followed up between 2010 and 2014 in 16 European countries. Patients in high-incidence countries compared with low-incidence countries were treated more frequently with standardized regimen (83.2% vs. 9.9%), had delayed treatment initiation (median, 111 vs. 28 d), developed more additional drug resistance (23% vs. 5.8%), and had increased mortality (9.4% vs. 1.9%). Only 20.1% of patients using pyrazinamide had proven susceptibility to the drug. Applying World Health Organization outcome definitions, frequency of cure (38.7% vs. 9.7%) was higher in high-incidence countries. Simplified outcome definitions that include 1 year of follow-up after the end of treatment showed similar frequency of relapse-free cure in low- (58.3%), intermediate- (55.8%), and high-incidence (57.1%) countries, but highest frequency of failure in high-incidence countries (24.1% vs. 14.6%). CONCLUSIONS: Conventional standard MDR-TB treatment regimens resulted in a higher frequency of failure compared with individualized treatments. Overall, cure from MDR-TB is substantially more frequent than previously anticipated, and poorly reflected by World Health Organization outcome definitions.
Amsterdam Institute for Global Health and Development Amsterdam the Netherlands
Asklepios Klinik Gauting Gauting Germany
Balti Municipal Hospital Balti Republic of Moldova
Barts Health NHS Trust London United Kingdom
Department of Medicine Karolinska Institute Stockholm Sweden; and
Department of Medicine University of Namibia School of Medicine Windhoek Namibia
EpiUnit Institute of Public Health Porto University Porto Portugal
German Center for Infection Research Borstel Germany
Heart of England Foundation Trust Birmingham United Kingdom
Homerton University Hospital London United Kingdom
Hospital Universitari Vall d'Hebron Research Institute IDIAP Jordi Gol Barcelona Spain
Institute of Phthisiopneumology Chisinau Republic of Moldova
International Health Infectious Diseases University of Lübeck Lübeck Germany
Marius Nasta Institut Bucharest Romania
National Institute for Health Development Tallinn Estonia
National Institute for Infectious Diseases L Spallanzani Rome Italy
National Tuberculosis Reference Laboratory Chisinau Republic of Moldova
Ospedale Eugenio Morelli Reference Hospital for MDR and HIV TB Sondalo Italy
Otto Wagner Hospital Vienna Austria
Queen Mary University London United Kingdom
Republican Research and Practical Centre for Pulmonology and Tuberculosis Minsk Belarus
Riga East University Hospital Tuberculosis and Lung Diseases Centre Riga Latvia
St James's Hospital Dublin Ireland
Statens Serum Institut Copenhagen Denmark
Tartu University Lung Hospital Tartu Estonia
Thomayer University Hospital Prague Czech Republic
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