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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.
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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, ,


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, , (click to view)

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, ,

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BMC infectious diseases 2017 08 1517(1) 571 doi 10.1186/s12879-017-2669-1
Abstract
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.

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