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Implementation of genotype MTBDRplus reduces time to multidrug-resistant tuberculosis therapy initiation in South Africa.
- Source :
-
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2013 Feb; Vol. 56 (4), pp. 503-8. Date of Electronic Publication: 2012 Oct 22. - Publication Year :
- 2013
-
Abstract
- Background: Diagnosis of drug resistance and timely initiation of multidrug-resistant (MDR) tuberculosis therapy are essential to reduce transmission and improve patient outcomes. We sought to determine whether implementation of the rapid MTBDRplus diagnostic shortened the time from specimen collection to patient MDR tuberculosis therapy initiation.<br />Methods: We conducted a retrospective cohort analysis of 197 MDR tuberculosis patients treated at Brewelskloof, a rural tuberculosis hospital in Western Cape Province, South Africa, between 2007 and 2011.<br />Results: Eighty-nine patients (45%) were tested using conventional liquid culture and drug susceptibility testing (DST) on solid medium and 108 (55%) were tested using the MTBDRplus assay after positive acid-fast bacilli or culture. Median time from sample taken to therapy initiation was reduced from 80 days (interquartile range [IQR] 62-100) for conventional DST to 55 days (IQR 37.5-78) with the MTBDRplus. Although the laboratory processing time declined significantly, operational delays persisted both in the laboratory and the clinical infrastructure for getting patients started on treatment. In multivariate analysis, patients tested using the MTBDRplus test had a reduced risk of starting treatment 60 days or more after sputum collection of 0.52 (P < .0001) compared with patients tested with culture-based DST, after adjustment for smear status and site of disease.<br />Conclusions: Use of MTBDRplus significantly reduced time to MDR tuberculosis treatment initiation. However, DST reporting to clinics was delayed by more than 1 week due, in part, to laboratory operational delays, including dependence on smear and culture positivity prior to MTBDRplus performance. In addition, once MDR tuberculosis was reported, delays in contacting patients and initiating therapy require improvements in clinical infrastructure.
- Subjects :
- Adult
Cohort Studies
Female
Genotype
Humans
Male
Microbial Sensitivity Tests methods
Middle Aged
Mycobacterium tuberculosis drug effects
Mycobacterium tuberculosis isolation & purification
Retrospective Studies
Sensitivity and Specificity
South Africa
Time Factors
Tuberculosis, Multidrug-Resistant diagnosis
Young Adult
Antitubercular Agents therapeutic use
Mycobacterium tuberculosis genetics
Tuberculosis, Multidrug-Resistant genetics
Subjects
Details
- Language :
- English
- ISSN :
- 1537-6591
- Volume :
- 56
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
- Publication Type :
- Academic Journal
- Accession number :
- 23090928
- Full Text :
- https://doi.org/10.1093/cid/cis920