TY - JOUR T1 - Implementation of rapid drug-susceptibility testing for patients at high risk of multidrug-resistant tuberculosis in Cambodia JF - European Respiratory Journal JO - Eur Respir J VL - 42 IS - Suppl 57 SP - P2775 AU - Natalie Lorent AU - Chanda Kong AU - Reaksmey Pe AU - Tharin Kim AU - Sopheak Sok AU - Sopheak Thai AU - Rigouts Leen AU - Lynen Lut Y1 - 2013/09/01 UR - http://erj.ersjournals.com/content/42/Suppl_57/P2775.abstract N2 - Introduction: WHO recommends rapid DST for all patients at increased risk of MDR TB, which has substantial logistical, financial and operational implications for low-income, high TB burden countries.Aim: To evaluate yield and feasibility of implementing rapid DST in a referral TB clinic in Phnom Penh, Cambodia.Methods: Prospective cohort study. All consecutive patients seen between 1/2/’12-1/2/’13 fulfilling any criterion for DST (i.e. prior TB treatment, exposure to MDR TB, new TB with smear-positivity at end of intensive phase, HIV-infection) underwent Xpert® MTB/RIF, conventional culture/DST, and MTBDRPlus® line probe assay (LPA) if Xpert RIF-resistant.Results: 132/343 patients with active TB disease were eligible for rapid DST (median age 42 years (IQR 32-52), 71 male (54%)): 61 (46%) HIV-infected patients, 44 (42%) patients with previous TB (34 completed treatment, 9 interrupted, 2 relapsed), 25 (20%) non-converters at end of intensive phase; 1 MDR TB contact. Xpert RIF-resistance was detected in 12/132 cases (number needed to test: 11). LPA confirmed 5 as MDR TB, conventional culture/DST 9 (1 rifampicin mono-resistance, 2 pending). 11 patients were referred for second line treatment within 8 days (1-19) of providing sputum (one refused), with 10 effectively started within 17 days (14-30) (one died). Treatment delays were due to pending confirmatory DST and limited treatment capacity.Conclusion: Xpert rapidly and adequately identified TB patients eligible for second line drugs. Our data support the recent recommendation that confirmatory LPA-testing is not required in patients at high risk for MDR TB identified by Xpert as RIF-resistant. ER -