Multidrug-Resistant Tuberculosis Treatment Outcomes in Relation to Treatment and Initial Versus Acquired Second-Line Drug Resistance
Background. Resistance to second-line drugs develops during treatment of multidrug-resistant (MDR) tuberculosis, but the impact on treatment outcome has not been determined. Methods. Patients with MDR tuberculosis starting second-line drug treatment were enrolled in a prospective cohort study. Sputu...
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| Veröffentlicht in: | Clinical infectious diseases 2016-02, Vol.62 (4), p.418-430 |
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| creator | Cegielski, J. Peter Kurbatova, Ekaterina van der Walt, Martie Brand, Jeannette Ershova, Julia Tupasi, Thelma Caoili, Janice Campos Dalton, Tracy Contreras, Carmen Yagui, Martin Bayona, Jaime Kvasnovsky, Charlotte Leimane, Vaira Kuksa, Liga Chen, Michael P. Via, Laura E. Hwang, Soo Hee Wolfgang, Melanie Volchenkov, Grigory V. Somova, Tatiana Smith, Sarah E. Akksilp, Somsak Wattanaamornkiet, Wanpen Kim, Hee Jin Kim, Chang-ki Kazennyy, Boris Y. Khorosheva, Tatiana Kliiman, Kai Viiklepp, Piret Jou, Ruwen Huang, Angela Song-En Vasilyeva, Irina A. Demikhova, Olga V. |
| description | Background. Resistance to second-line drugs develops during treatment of multidrug-resistant (MDR) tuberculosis, but the impact on treatment outcome has not been determined. Methods. Patients with MDR tuberculosis starting second-line drug treatment were enrolled in a prospective cohort study. Sputum cultures were analyzed at a central reference laboratory. We compared subjects with successful and poor treatment outcomes in terms of (1) initial and acquired resistance to fluoroquinolones and second-line injectable drugs (SLIs) and (2) treatment regimens. Results. Of 1244 patients with MDR tuberculosis, 973 (78.2%) had known outcomes and 232 (18.6%) were lost to follow-up. Among those with known outcomes, treatment succeeded in 85.8% with plain MDR tuberculosis, 69.7% with initial resistance to either a fluoroquinolone or an SLI, 37.5% with acquired resistance to a fluoroquinolone or SLI, 29.3% with initial and 13.0% with acquired extensively drug-resistant tuberculosis (P < .001 for trend). In contrast, among those with known outcomes, treatment success increased stepwise from 41.6% to 92.3% as the number of drugs proven effective increased from ≤1 to ≥5 (P < .001 for trend), while acquired drug resistance decreased from 12% to 16% range, depending on the drug, down to 0%–2% (P < .001 for trend). In multivariable analysis, the adjusted odds of treatment success decreased 0.62-fold (95% confidence interval, .56–.69) for each increment in drug resistance and increased 2.1-fold (1.40–3.18) for each additional effective drug, controlling for differences between programs and patients. Specific treatment, patient, and program variables were also associated with treatment outcome. Conclusions. Increasing drug resistance was associated in a logical stepwise manner with poor treatment outcomes. Acquired resistance was worse than initial resistance to the same drugs. Increasing numbers of effective drugs, specific drugs, and specific program characteristics were associated with better outcomes and less acquired resistance. |
| doi_str_mv | 10.1093/cid/civ910 |
| format | Article |
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Peter ; Kurbatova, Ekaterina ; van der Walt, Martie ; Brand, Jeannette ; Ershova, Julia ; Tupasi, Thelma ; Caoili, Janice Campos ; Dalton, Tracy ; Contreras, Carmen ; Yagui, Martin ; Bayona, Jaime ; Kvasnovsky, Charlotte ; Leimane, Vaira ; Kuksa, Liga ; Chen, Michael P. ; Via, Laura E. ; Hwang, Soo Hee ; Wolfgang, Melanie ; Volchenkov, Grigory V. ; Somova, Tatiana ; Smith, Sarah E. ; Akksilp, Somsak ; Wattanaamornkiet, Wanpen ; Kim, Hee Jin ; Kim, Chang-ki ; Kazennyy, Boris Y. ; Khorosheva, Tatiana ; Kliiman, Kai ; Viiklepp, Piret ; Jou, Ruwen ; Huang, Angela Song-En ; Vasilyeva, Irina A. ; Demikhova, Olga V.</creator><creatorcontrib>Cegielski, J. Peter ; Kurbatova, Ekaterina ; van der Walt, Martie ; Brand, Jeannette ; Ershova, Julia ; Tupasi, Thelma ; Caoili, Janice Campos ; Dalton, Tracy ; Contreras, Carmen ; Yagui, Martin ; Bayona, Jaime ; Kvasnovsky, Charlotte ; Leimane, Vaira ; Kuksa, Liga ; Chen, Michael P. ; Via, Laura E. ; Hwang, Soo Hee ; Wolfgang, Melanie ; Volchenkov, Grigory V. ; Somova, Tatiana ; Smith, Sarah E. ; Akksilp, Somsak ; Wattanaamornkiet, Wanpen ; Kim, Hee Jin ; Kim, Chang-ki ; Kazennyy, Boris Y. ; Khorosheva, Tatiana ; Kliiman, Kai ; Viiklepp, Piret ; Jou, Ruwen ; Huang, Angela Song-En ; Vasilyeva, Irina A. ; Demikhova, Olga V. ; Global PETTS Investigators ; Global PETTS Investigators ; on behalf of the Global PETTS Investigators</creatorcontrib><description>Background. Resistance to second-line drugs develops during treatment of multidrug-resistant (MDR) tuberculosis, but the impact on treatment outcome has not been determined. Methods. Patients with MDR tuberculosis starting second-line drug treatment were enrolled in a prospective cohort study. Sputum cultures were analyzed at a central reference laboratory. We compared subjects with successful and poor treatment outcomes in terms of (1) initial and acquired resistance to fluoroquinolones and second-line injectable drugs (SLIs) and (2) treatment regimens. Results. Of 1244 patients with MDR tuberculosis, 973 (78.2%) had known outcomes and 232 (18.6%) were lost to follow-up. Among those with known outcomes, treatment succeeded in 85.8% with plain MDR tuberculosis, 69.7% with initial resistance to either a fluoroquinolone or an SLI, 37.5% with acquired resistance to a fluoroquinolone or SLI, 29.3% with initial and 13.0% with acquired extensively drug-resistant tuberculosis (P < .001 for trend). In contrast, among those with known outcomes, treatment success increased stepwise from 41.6% to 92.3% as the number of drugs proven effective increased from ≤1 to ≥5 (P < .001 for trend), while acquired drug resistance decreased from 12% to 16% range, depending on the drug, down to 0%–2% (P < .001 for trend). In multivariable analysis, the adjusted odds of treatment success decreased 0.62-fold (95% confidence interval, .56–.69) for each increment in drug resistance and increased 2.1-fold (1.40–3.18) for each additional effective drug, controlling for differences between programs and patients. Specific treatment, patient, and program variables were also associated with treatment outcome. Conclusions. Increasing drug resistance was associated in a logical stepwise manner with poor treatment outcomes. Acquired resistance was worse than initial resistance to the same drugs. Increasing numbers of effective drugs, specific drugs, and specific program characteristics were associated with better outcomes and less acquired resistance.</description><identifier>ISSN: 1058-4838</identifier><identifier>EISSN: 1537-6591</identifier><identifier>DOI: 10.1093/cid/civ910</identifier><identifier>PMID: 26508515</identifier><language>eng</language><publisher>United States: Oxford University Press</publisher><subject>Adolescent ; Adult ; Aged ; and Commentaries ; Antitubercular Agents - therapeutic use ; ARTICLES AND COMMENTARIES ; Clinical outcomes ; Drug resistance ; Drug Resistance, Multiple, Bacterial ; Female ; Humans ; Male ; Medical treatment ; Middle Aged ; Multidrug resistant organisms ; Mycobacterium tuberculosis - drug effects ; Mycobacterium tuberculosis - isolation & purification ; Prospective Studies ; Sputum - microbiology ; Treatment Outcome ; Tuberculosis ; Tuberculosis, Multidrug-Resistant - drug therapy ; Young Adult</subject><ispartof>Clinical infectious diseases, 2016-02, Vol.62 (4), p.418-430</ispartof><rights>Copyright © 2016 Oxford University Press on behalf of the Infectious Diseases Society of America</rights><rights>Published by Oxford University Press for the Infectious Diseases Society of America 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US.</rights><rights>Copyright Oxford University Press, UK Feb 15, 2016</rights><rights>Published by Oxford University Press for the Infectious Diseases Society of America 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US. 2015</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c428t-f26013b1fffc360f4cd988374014450bc81c3280f33295b37ef46b443a075d2c3</citedby><cites>FETCH-LOGICAL-c428t-f26013b1fffc360f4cd988374014450bc81c3280f33295b37ef46b443a075d2c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.jstor.org/stable/pdf/26370244$$EPDF$$P50$$Gjstor$$H</linktopdf><linktohtml>$$Uhttps://www.jstor.org/stable/26370244$$EHTML$$P50$$Gjstor$$H</linktohtml><link.rule.ids>230,314,777,781,800,882,27905,27906,57998,58231</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26508515$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cegielski, J. Peter</creatorcontrib><creatorcontrib>Kurbatova, Ekaterina</creatorcontrib><creatorcontrib>van der Walt, Martie</creatorcontrib><creatorcontrib>Brand, Jeannette</creatorcontrib><creatorcontrib>Ershova, Julia</creatorcontrib><creatorcontrib>Tupasi, Thelma</creatorcontrib><creatorcontrib>Caoili, Janice Campos</creatorcontrib><creatorcontrib>Dalton, Tracy</creatorcontrib><creatorcontrib>Contreras, Carmen</creatorcontrib><creatorcontrib>Yagui, Martin</creatorcontrib><creatorcontrib>Bayona, Jaime</creatorcontrib><creatorcontrib>Kvasnovsky, Charlotte</creatorcontrib><creatorcontrib>Leimane, Vaira</creatorcontrib><creatorcontrib>Kuksa, Liga</creatorcontrib><creatorcontrib>Chen, Michael P.</creatorcontrib><creatorcontrib>Via, Laura E.</creatorcontrib><creatorcontrib>Hwang, Soo Hee</creatorcontrib><creatorcontrib>Wolfgang, Melanie</creatorcontrib><creatorcontrib>Volchenkov, Grigory V.</creatorcontrib><creatorcontrib>Somova, Tatiana</creatorcontrib><creatorcontrib>Smith, Sarah E.</creatorcontrib><creatorcontrib>Akksilp, Somsak</creatorcontrib><creatorcontrib>Wattanaamornkiet, Wanpen</creatorcontrib><creatorcontrib>Kim, Hee Jin</creatorcontrib><creatorcontrib>Kim, Chang-ki</creatorcontrib><creatorcontrib>Kazennyy, Boris Y.</creatorcontrib><creatorcontrib>Khorosheva, Tatiana</creatorcontrib><creatorcontrib>Kliiman, Kai</creatorcontrib><creatorcontrib>Viiklepp, Piret</creatorcontrib><creatorcontrib>Jou, Ruwen</creatorcontrib><creatorcontrib>Huang, Angela Song-En</creatorcontrib><creatorcontrib>Vasilyeva, Irina A.</creatorcontrib><creatorcontrib>Demikhova, Olga V.</creatorcontrib><creatorcontrib>Global PETTS Investigators</creatorcontrib><creatorcontrib>Global PETTS Investigators</creatorcontrib><creatorcontrib>on behalf of the Global PETTS Investigators</creatorcontrib><title>Multidrug-Resistant Tuberculosis Treatment Outcomes in Relation to Treatment and Initial Versus Acquired Second-Line Drug Resistance</title><title>Clinical infectious diseases</title><addtitle>Clin Infect Dis</addtitle><description>Background. Resistance to second-line drugs develops during treatment of multidrug-resistant (MDR) tuberculosis, but the impact on treatment outcome has not been determined. Methods. Patients with MDR tuberculosis starting second-line drug treatment were enrolled in a prospective cohort study. Sputum cultures were analyzed at a central reference laboratory. We compared subjects with successful and poor treatment outcomes in terms of (1) initial and acquired resistance to fluoroquinolones and second-line injectable drugs (SLIs) and (2) treatment regimens. Results. Of 1244 patients with MDR tuberculosis, 973 (78.2%) had known outcomes and 232 (18.6%) were lost to follow-up. Among those with known outcomes, treatment succeeded in 85.8% with plain MDR tuberculosis, 69.7% with initial resistance to either a fluoroquinolone or an SLI, 37.5% with acquired resistance to a fluoroquinolone or SLI, 29.3% with initial and 13.0% with acquired extensively drug-resistant tuberculosis (P < .001 for trend). In contrast, among those with known outcomes, treatment success increased stepwise from 41.6% to 92.3% as the number of drugs proven effective increased from ≤1 to ≥5 (P < .001 for trend), while acquired drug resistance decreased from 12% to 16% range, depending on the drug, down to 0%–2% (P < .001 for trend). In multivariable analysis, the adjusted odds of treatment success decreased 0.62-fold (95% confidence interval, .56–.69) for each increment in drug resistance and increased 2.1-fold (1.40–3.18) for each additional effective drug, controlling for differences between programs and patients. Specific treatment, patient, and program variables were also associated with treatment outcome. Conclusions. Increasing drug resistance was associated in a logical stepwise manner with poor treatment outcomes. Acquired resistance was worse than initial resistance to the same drugs. Increasing numbers of effective drugs, specific drugs, and specific program characteristics were associated with better outcomes and less acquired resistance.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>and Commentaries</subject><subject>Antitubercular Agents - therapeutic use</subject><subject>ARTICLES AND COMMENTARIES</subject><subject>Clinical outcomes</subject><subject>Drug resistance</subject><subject>Drug Resistance, Multiple, Bacterial</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Medical treatment</subject><subject>Middle Aged</subject><subject>Multidrug resistant organisms</subject><subject>Mycobacterium tuberculosis - drug effects</subject><subject>Mycobacterium tuberculosis - isolation & purification</subject><subject>Prospective Studies</subject><subject>Sputum - microbiology</subject><subject>Treatment Outcome</subject><subject>Tuberculosis</subject><subject>Tuberculosis, Multidrug-Resistant - drug therapy</subject><subject>Young Adult</subject><issn>1058-4838</issn><issn>1537-6591</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkc1rFTEUxYMotlY37pWAGylMvZkkk8ymUKrVwpNCfboNmUym5jGTtPkouPcPN-W15dlFSLj3x7nn5iD0lsARgZ5-Mm6s57Yn8AztE05F0_GePK9v4LJhkso99CqlDQAhEvhLtNd2HCQnfB_9_V7m7MZYrppLm1zK2me8LoONpsyhFvA6Wp0XW8sXJZuw2ISdx5d21tkFj3PYIbQf8bl32ekZ_7IxlYRPzE1x0Y74hzXBj83KeYs_13n4YZ6xr9GLSc_Jvrm_D9DPsy_r02_N6uLr-enJqjGslbmZ2g4IHcg0TYZ2MDEz9lJSwYAwxmEwkhjaSpgobXs-UGEn1g2MUQ2Cj62hB-h4q3tdhsWOplqOelbX0S06_lFBO_V_x7vf6ircKiZaTiWpAh_vBWK4KTZltbhk7Dxrb0NJiogOeiBCdhX98ATdhBJ9Xe-OYgKElLxSh1vKxJBStNOjGQLqLlxVw1XbcCv8ftf-I_qQZgXebYFNyiHu9KmAtv7DPwP7rJQ</recordid><startdate>20160215</startdate><enddate>20160215</enddate><creator>Cegielski, J. Peter</creator><creator>Kurbatova, Ekaterina</creator><creator>van der Walt, Martie</creator><creator>Brand, Jeannette</creator><creator>Ershova, Julia</creator><creator>Tupasi, Thelma</creator><creator>Caoili, Janice Campos</creator><creator>Dalton, Tracy</creator><creator>Contreras, Carmen</creator><creator>Yagui, Martin</creator><creator>Bayona, Jaime</creator><creator>Kvasnovsky, Charlotte</creator><creator>Leimane, Vaira</creator><creator>Kuksa, Liga</creator><creator>Chen, Michael P.</creator><creator>Via, Laura E.</creator><creator>Hwang, Soo Hee</creator><creator>Wolfgang, Melanie</creator><creator>Volchenkov, Grigory V.</creator><creator>Somova, Tatiana</creator><creator>Smith, Sarah E.</creator><creator>Akksilp, Somsak</creator><creator>Wattanaamornkiet, Wanpen</creator><creator>Kim, Hee Jin</creator><creator>Kim, Chang-ki</creator><creator>Kazennyy, Boris Y.</creator><creator>Khorosheva, Tatiana</creator><creator>Kliiman, Kai</creator><creator>Viiklepp, Piret</creator><creator>Jou, Ruwen</creator><creator>Huang, Angela Song-En</creator><creator>Vasilyeva, Irina A.</creator><creator>Demikhova, Olga V.</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>7T2</scope><scope>7T7</scope><scope>7U7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>P64</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20160215</creationdate><title>Multidrug-Resistant Tuberculosis Treatment Outcomes in Relation to Treatment and Initial Versus Acquired Second-Line Drug Resistance</title><author>Cegielski, J. Peter ; Kurbatova, Ekaterina ; van der Walt, Martie ; Brand, Jeannette ; Ershova, Julia ; Tupasi, Thelma ; Caoili, Janice Campos ; Dalton, Tracy ; Contreras, Carmen ; Yagui, Martin ; Bayona, Jaime ; Kvasnovsky, Charlotte ; Leimane, Vaira ; Kuksa, Liga ; Chen, Michael P. ; Via, Laura E. ; Hwang, Soo Hee ; Wolfgang, Melanie ; Volchenkov, Grigory V. ; Somova, Tatiana ; Smith, Sarah E. ; Akksilp, Somsak ; Wattanaamornkiet, Wanpen ; Kim, Hee Jin ; Kim, Chang-ki ; Kazennyy, Boris Y. ; Khorosheva, Tatiana ; Kliiman, Kai ; Viiklepp, Piret ; Jou, Ruwen ; Huang, Angela Song-En ; Vasilyeva, Irina A. ; Demikhova, Olga V.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c428t-f26013b1fffc360f4cd988374014450bc81c3280f33295b37ef46b443a075d2c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>and Commentaries</topic><topic>Antitubercular Agents - therapeutic use</topic><topic>ARTICLES AND COMMENTARIES</topic><topic>Clinical outcomes</topic><topic>Drug resistance</topic><topic>Drug Resistance, Multiple, Bacterial</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Medical treatment</topic><topic>Middle Aged</topic><topic>Multidrug resistant organisms</topic><topic>Mycobacterium tuberculosis - drug effects</topic><topic>Mycobacterium tuberculosis - isolation & purification</topic><topic>Prospective Studies</topic><topic>Sputum - microbiology</topic><topic>Treatment Outcome</topic><topic>Tuberculosis</topic><topic>Tuberculosis, Multidrug-Resistant - drug therapy</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cegielski, J. 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Peter</au><au>Kurbatova, Ekaterina</au><au>van der Walt, Martie</au><au>Brand, Jeannette</au><au>Ershova, Julia</au><au>Tupasi, Thelma</au><au>Caoili, Janice Campos</au><au>Dalton, Tracy</au><au>Contreras, Carmen</au><au>Yagui, Martin</au><au>Bayona, Jaime</au><au>Kvasnovsky, Charlotte</au><au>Leimane, Vaira</au><au>Kuksa, Liga</au><au>Chen, Michael P.</au><au>Via, Laura E.</au><au>Hwang, Soo Hee</au><au>Wolfgang, Melanie</au><au>Volchenkov, Grigory V.</au><au>Somova, Tatiana</au><au>Smith, Sarah E.</au><au>Akksilp, Somsak</au><au>Wattanaamornkiet, Wanpen</au><au>Kim, Hee Jin</au><au>Kim, Chang-ki</au><au>Kazennyy, Boris Y.</au><au>Khorosheva, Tatiana</au><au>Kliiman, Kai</au><au>Viiklepp, Piret</au><au>Jou, Ruwen</au><au>Huang, Angela Song-En</au><au>Vasilyeva, Irina A.</au><au>Demikhova, Olga V.</au><aucorp>Global PETTS Investigators</aucorp><aucorp>Global PETTS Investigators</aucorp><aucorp>on behalf of the Global PETTS Investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Multidrug-Resistant Tuberculosis Treatment Outcomes in Relation to Treatment and Initial Versus Acquired Second-Line Drug Resistance</atitle><jtitle>Clinical infectious diseases</jtitle><addtitle>Clin Infect Dis</addtitle><date>2016-02-15</date><risdate>2016</risdate><volume>62</volume><issue>4</issue><spage>418</spage><epage>430</epage><pages>418-430</pages><issn>1058-4838</issn><eissn>1537-6591</eissn><abstract>Background. Resistance to second-line drugs develops during treatment of multidrug-resistant (MDR) tuberculosis, but the impact on treatment outcome has not been determined. Methods. Patients with MDR tuberculosis starting second-line drug treatment were enrolled in a prospective cohort study. Sputum cultures were analyzed at a central reference laboratory. We compared subjects with successful and poor treatment outcomes in terms of (1) initial and acquired resistance to fluoroquinolones and second-line injectable drugs (SLIs) and (2) treatment regimens. Results. Of 1244 patients with MDR tuberculosis, 973 (78.2%) had known outcomes and 232 (18.6%) were lost to follow-up. Among those with known outcomes, treatment succeeded in 85.8% with plain MDR tuberculosis, 69.7% with initial resistance to either a fluoroquinolone or an SLI, 37.5% with acquired resistance to a fluoroquinolone or SLI, 29.3% with initial and 13.0% with acquired extensively drug-resistant tuberculosis (P < .001 for trend). In contrast, among those with known outcomes, treatment success increased stepwise from 41.6% to 92.3% as the number of drugs proven effective increased from ≤1 to ≥5 (P < .001 for trend), while acquired drug resistance decreased from 12% to 16% range, depending on the drug, down to 0%–2% (P < .001 for trend). In multivariable analysis, the adjusted odds of treatment success decreased 0.62-fold (95% confidence interval, .56–.69) for each increment in drug resistance and increased 2.1-fold (1.40–3.18) for each additional effective drug, controlling for differences between programs and patients. Specific treatment, patient, and program variables were also associated with treatment outcome. Conclusions. Increasing drug resistance was associated in a logical stepwise manner with poor treatment outcomes. Acquired resistance was worse than initial resistance to the same drugs. Increasing numbers of effective drugs, specific drugs, and specific program characteristics were associated with better outcomes and less acquired resistance.</abstract><cop>United States</cop><pub>Oxford University Press</pub><pmid>26508515</pmid><doi>10.1093/cid/civ910</doi><tpages>13</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1058-4838 |
| ispartof | Clinical infectious diseases, 2016-02, Vol.62 (4), p.418-430 |
| issn | 1058-4838 1537-6591 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_4725381 |
| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Jstor Complete Legacy; Oxford University Press Journals All Titles (1996-Current); Alma/SFX Local Collection |
| subjects | Adolescent Adult Aged and Commentaries Antitubercular Agents - therapeutic use ARTICLES AND COMMENTARIES Clinical outcomes Drug resistance Drug Resistance, Multiple, Bacterial Female Humans Male Medical treatment Middle Aged Multidrug resistant organisms Mycobacterium tuberculosis - drug effects Mycobacterium tuberculosis - isolation & purification Prospective Studies Sputum - microbiology Treatment Outcome Tuberculosis Tuberculosis, Multidrug-Resistant - drug therapy Young Adult |
| title | Multidrug-Resistant Tuberculosis Treatment Outcomes in Relation to Treatment and Initial Versus Acquired Second-Line Drug Resistance |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-19T08%3A18%3A41IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-jstor_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Multidrug-Resistant%20Tuberculosis%20Treatment%20Outcomes%20in%20Relation%20to%20Treatment%20and%20Initial%20Versus%20Acquired%20Second-Line%20Drug%20Resistance&rft.jtitle=Clinical%20infectious%20diseases&rft.au=Cegielski,%20J.%20Peter&rft.aucorp=Global%20PETTS%20Investigators&rft.date=2016-02-15&rft.volume=62&rft.issue=4&rft.spage=418&rft.epage=430&rft.pages=418-430&rft.issn=1058-4838&rft.eissn=1537-6591&rft_id=info:doi/10.1093/cid/civ910&rft_dat=%3Cjstor_pubme%3E26370244%3C/jstor_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1764707885&rft_id=info:pmid/26508515&rft_jstor_id=26370244&rfr_iscdi=true |