BMC infectious diseases
BACKGROUND: Drug susceptibility testing (DST) patterns of Mycobacterium tuberculosis (MTB) from patients with rifampicin-resistant tuberculosis (RR-TB) or multidrug-resistant TB (MDR-TB; or resistant to rifampicin and isoniazid (INH)), are important to guide preventive therapy for their household contacts (HHCs).
METHODS: As part of a feasibility study done in preparation for an MDR-TB preventive therapy trial in HHCs, smear, Xpert MTB/RIF, Hain MTBDRplus, culture and DST results of index MDR-TB patients were obtained from routine TB programs. A sputum sample was collected at study entry and evaluated by the same tests. Not all tests were performed on all specimens due to variations in test availability.
RESULTS: Three hundred eight adults with reported RR/MDR-TB were enrolled from 16 participating sites in 8 countries. Their median age was 36 years, and 36% were HIV-infected. Routine testing on all 308 were confirmed as having RR-TB, but only 75% were documented as having MDR-TB. The majority of those not classified as having MDR-TB were because only rifampicin resistance was tested. At study entry (median 59 days after MDR-TB treatment initiation), 280 participants (91%) were able to produce sputum for the study, of whom 147 (53%) still had detectable MTB. All but 2 of these 147 had rifampicin DST done, with resistance detected in 89%. Almost half (47%) of the 147 specimens had INH DST done, with 83% resistance. Therefore, 20% of the 280 study specimens had MDR-TB confirmed. Overall, DST for second-line drugs were available in only 35% of the 308 routine specimens and 15% of 280 study specimens.
CONCLUSIONS: RR-TB was detected in all routine specimens but only 75% had documented MDR-TB, illustrating the need for expanded DST beyond Xpert MTB/RIF to target preventive therapy for HHC.
Adult, Antitubercular Agents, Cross-Sectional Studies, Feasibility Studies, Female, Humans, Isoniazid, Male, Microbial Sensitivity Tests, Mycobacterium tuberculosis, Rifampin, Sputum, Tuberculosis, Multidrug-Resistant
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Demers, Anne-Marie; Kim, Soyeon; McCallum, Sara; Eisenach, Kathleen; Hughes, Michael; Naini, Linda; Mendoza-Ticona, Alberto; Pradhan, Neeta; Narunsky, Kim; Poongulali, Selvamuthu; Badal-Faesen, Sharlaa; Upton, Caryn; Smith, Elizabeth; Shah, N Sarita; Churchyard, Gavin; Gupta, Amita; Hesseling, Anneke; Swindells, Susan; and ACTG A5300/IMPAACT I2003 PHOENIx Feasibility study team, "Drug Susceptibility Patterns of Mycobacterium Tuberculosis from Adults With Multidrug-Resistant Tuberculosis and Implications for a Household Contact Preventive Therapy Trial" (2021). Journal Articles: Internal Medicine. 18.