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High frequency of resistance, lack of clinical benefit, and poor outcomes in capreomycin treated South African patients with extensively drug-resistant tuberculosis
- Source :
- PLoS ONE, Vol 10, Iss 4, p e0123655 (2015), PLoS ONE, PLoS One
- Publication Year :
- 2015
- Publisher :
- Public Library of Science (PLoS), 2015.
-
Abstract
- BACKGROUND: There are limited data about the epidemiology and treatment-related outcomes associated with capreomycin resistance in patients with XDR-TB. Capreomycin achieves high serum concentrations relative to MIC but whether capreomycin has therapeutic benefit despite microbiological resistance remains unclear. METHODS: We reviewed the susceptibility profiles and outcomes associated with capreomycin usage in patients diagnosed with XDR-TB between August 2002 and October 2012 in two provinces of South Africa. Patients whose isolates were genotypically tested for capreomycin resistance were included in the analysis. RESULTS: Of 178 XDR-TB patients 41% were HIV-infected. 87% (154/178) isolates contained a capreomycin resistance-conferring mutation [80% (143/178) rrs A1401G and 6% (11/178) were heteroresistant (containing both the rrs A1401G mutation and wild-type sequences)]. Previous MDR-TB treatment, prior usage of kanamycin, or strain type was not associated with capreomycin resistance. 92% (163/178) of XDR-TB patients were empirically treated with capreomycin. Capreomycin resistance decreased the odds of sputum culture conversion. In capreomycin sensitive and resistant persons combined weight at diagnosis was the only independent predictor for survival (p=
- Subjects :
- Adult
Male
medicine.medical_specialty
Tuberculosis
Capreomycin
Extensively Drug-Resistant Tuberculosis
Antitubercular Agents
lcsh:Medicine
HIV Infections
Microbial Sensitivity Tests
Drug resistance
Mycobacterium tuberculosis
South Africa
Pharmacotherapy
Drug Resistance, Multiple, Bacterial
Internal medicine
medicine
Tuberculosis diagnosis and management
Humans
Treatment Failure
Multi-drug-resistant tuberculosis
lcsh:Science
Retrospective Studies
Multidisciplinary
biology
Coinfection
business.industry
lcsh:R
Sputum
Extensively drug-resistant tuberculosis
HIV diagnosis and management
medicine.disease
biology.organism_classification
humanities
Treatment Outcome
Drug screening
Mutation
Immunology
Female
lcsh:Q
Drug therapy
business
Research Article
medicine.drug
Subjects
Details
- Language :
- English
- ISSN :
- 19326203
- Volume :
- 10
- Issue :
- 4
- Database :
- OpenAIRE
- Journal :
- PLoS ONE
- Accession number :
- edsair.doi.dedup.....741917fc593857e6e00a5936f9c56f8e