RT Journal Article
SR Electronic
T1 Clinical and operational value of the extensively drug-resistant tuberculosis definition
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 623
OP 626
DO 10.1183/09031936.00077307
VO 30
IS 4
A1 Migliori, G. B.
A1 Besozzi, G.
A1 Girardi, E.
A1 Kliiman, K.
A1 Lange, C.
A1 Toungoussova, O. S.
A1 Ferrara, G.
A1 Cirillo, D. M.
A1 Gori, A.
A1 Matteelli, A.
A1 Spanevello, A.
A1 Codecasa, L. R.
A1 Raviglione, M. C.
A1 SMIRA/TBNET Study Group
YR 2007
UL https://publications.ersnet.org//content/30/4/623.abstract
AB Currently, no information is available on the effect of resistance/susceptibility to first-line drugs different from isoniazid and rifampicin in determining the outcome of extensively drug-resistant tuberculosis (XDR-TB) patients, and whether being XDR-TB is a more accurate indicator of poor clinical outcome than being resistant to all first-line anti-tuberculosis (TB) drugs. To investigate this issue, a large series of multidrug-resistant TB (MDR-TB) and XDR-TB cases diagnosed in Estonia, Germany, Italy and the Russian Federation during the period 1999–2006 were analysed. Drug-susceptibility testing for first- and second-line anti-TB drugs, quality assurance and treatment delivery was performed according to World Health Organization recommendations in all study sites. Out of 4,583 culture-positive TB cases analysed, 361 (7.9%) were MDR and 64 (1.4%) were XDR. XDR-TB cases had a relative risk (RR) of 1.58 to have an unfavourable outcome compared with MDR-TB cases resistant to all first-line drugs (isoniazid, rifampicin ethambutol, streptomycin and, when tested, pyrazinamide), and an RR of 2.61 compared with “other” MDR-TB cases (those susceptible to at least one first-line anti-TB drug among ethambutol, pyrazinamide and streptomycin, regardless of resistance to the second-line drugs not defining XDR-TB). The emergence of extensively drug-resistant tuberculosis confirms that problems in tuberculosis management are still present in Europe. While waiting for new tools which will facilitate management of extensively drug-resistant tuberculosis, accessibility to quality diagnostic and treatment services should be urgently ensured and adequate public health policies should be rapidly implemented to prevent further development of drug resistance.