dc.contributor.author | Günther, G | |
dc.contributor.author | van Leth, F | |
dc.contributor.author | Alexandru, S | |
dc.contributor.author | Altet, N | |
dc.contributor.author | Avsar, K | |
dc.contributor.author | Bang, D | |
dc.contributor.author | Barbuta, R | |
dc.contributor.author | Bothamley, G | |
dc.contributor.author | Ciobanu, A | |
dc.contributor.author | Crudu, V | |
dc.contributor.author | Danilovits, M | |
dc.contributor.author | Dedicoat, M | |
dc.contributor.author | Duarte, R | |
dc.contributor.author | Gualano, G | |
dc.contributor.author | Kunst, H | |
dc.contributor.author | de Lange, W | |
dc.contributor.author | Leimane, V | |
dc.contributor.author | McLaughlin, A-M | |
dc.contributor.author | Magis-Escurra, C | |
dc.contributor.author | Muylle, I | |
dc.contributor.author | Polcová, V | |
dc.contributor.author | Popa, C | |
dc.contributor.author | Rumetshofer, R | |
dc.contributor.author | Skrahina, A | |
dc.contributor.author | Solodovnikova, V | |
dc.contributor.author | Spinu, V | |
dc.contributor.author | Tiberi, S | |
dc.contributor.author | Viiklepp, P | |
dc.contributor.author | Lange, C | |
dc.contributor.author | for TBNET | |
dc.date.accessioned | 2019-01-04T15:12:32Z | |
dc.date.available | 2017-10-16 | |
dc.date.available | 2019-01-04T15:12:32Z | |
dc.date.issued | 2018-08-01 | |
dc.date.submitted | 2018-11-21T09:16:22.936Z | |
dc.identifier.issn | 1073-449X | |
dc.identifier.uri | https://qmro.qmul.ac.uk/xmlui/handle/123456789/54099 | |
dc.description.abstract | 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. | en_US |
dc.description.sponsorship | German Center for Infection Research | en_US |
dc.format.extent | 379 - 386 | |
dc.language | eng | |
dc.language.iso | en | en_US |
dc.publisher | American Thoracic Society | en_US |
dc.relation.ispartof | Am J Respir Crit Care Med | |
dc.subject | management | en_US |
dc.subject | MDR-TB | en_US |
dc.subject | outcome definitions | en_US |
dc.subject | TBNET | en_US |
dc.subject | extensively drug-resistant TB | en_US |
dc.title | Clinical Management of Multidrug-Resistant Tuberculosis in 16 European Countries. | en_US |
dc.type | Article | en_US |
dc.identifier.doi | 10.1164/rccm.201710-2141OC | |
rioxxterms.funder | Default funder | en_US |
rioxxterms.identifier.project | FP7-223681 | en_US |
rioxxterms.funder.project | ccba015e-cfac-4c8f-876b-eb1ba118c73e | en_US |