TY - JOUR T1 - Drug resistance beyond extensively drug-resistant tuberculosis: individual patient data meta-analysis JF - European Respiratory Journal JO - Eur Respir J SP - 169 LP - 179 DO - 10.1183/09031936.00136312 VL - 42 IS - 1 AU - Giovanni Battista Migliori AU - Giovanni Sotgiu AU - Neel R. Gandhi AU - Dennis Falzon AU - Kathryn DeRiemer AU - Rosella Centis AU - Maria-Graciela Hollm-Delgado AU - Domingo Palmero AU - Carlos Pérez-Guzmán AU - Mario H. Vargas AU - Lia D'Ambrosio AU - Antonio Spanevello AU - Melissa Bauer AU - Edward D. Chan AU - H. Simon Schaaf AU - Salmaan Keshavjee AU - Timothy H. Holtz AU - Dick Menzies AU - The Collaborative Group for Meta-Analysis of Individual Patient Data in MDR-TB Y1 - 2013/07/01 UR - http://erj.ersjournals.com/content/42/1/169.abstract N2 - The broadest pattern of tuberculosis (TB) drug resistance for which a consensus definition exists is extensively drug-resistant (XDR)-TB. It is not known if additional drug resistance portends worsened patient outcomes. This study compares treatment outcomes of XDR-TB patients with and without additional resistance in order to explore the need for a new definition. Individual patient data on XDR-TB outcomes were included in a meta-analysis comparing outcomes between XDR alone and three nonmutually exclusive XDR-TB patient groups: XDR plus resistance to all the second-line injectables (sli) and capreomycin and kanamycin/amikacin (XDR+2sli) XDR plus resistance to second-line injectables and to more than one group 4 drug, i.e. ethionamide/protionamide, cycloserine/terizidone or para-aminosalicylic acid (XDR+sliG4) and XDR+sliG4 plus resistance to ethambutol and/or pyrazinamide (XDR+sliG4EZ). Of 405 XDR-TB cases, 301 were XDR alone, 68 XDR+2sli, 48 XDR+sliG4 and 42 XDR+sliG4EZ. In multivariate analysis, the odds of cure were significantly lower in XDR+2sli (adjusted OR 0.4, 95% CI 0.2–0.8) compared to XDR alone, while odds of failure and death were higher in all XDR patients with additional resistance (adjusted OR 2.6–2.8). Patients with additional resistance beyond XDR-TB showed poorer outcomes. Limitations in availability, accuracy and reproducibility of current drug susceptibility testing methods preclude the adoption of a useful definition beyond the one currently used for XDR-TB. ER -