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Outcomes from patients with presumed drug resistant tuberculosis in five reference centers in Brazil

Ramalho, D M P ; Miranda, P F C ; Andrade, M K ; Brígido, T ; Dalcolmo, M P ; Mesquita, E ; Dias, C F ; Gambirasio, A N ; Ueleres Braga, J ; Detjen, A ; Phillips, P P J ; Langley, I ; Fujiwara, P I ; Squire, S B ; Oliveira, M M ; Kritski, A L

BMC infectious diseases, 2017-08, Vol.17 (1), p.571-571, Article 571 [Periódico revisado por pares]

England: BioMed Central Ltd

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Título:
Outcomes from patients with presumed drug resistant tuberculosis in five reference centers in Brazil
Autor: Ramalho, D M P ; Miranda, P F C ; Andrade, M K ; Brígido, T ; Dalcolmo, M P ; Mesquita, E ; Dias, C F ; Gambirasio, A N ; Ueleres Braga, J ; Detjen, A ; Phillips, P P J ; Langley, I ; Fujiwara, P I ; Squire, S B ; Oliveira, M M ; Kritski, A L
Assuntos: Adult ; Aged ; Analysis ; Antitubercular Agents - therapeutic use ; Brazil ; Care and treatment ; Control ; Diagnosis ; Drug resistance ; Drug resistance in microorganisms ; Drug Resistance, Bacterial ; Drug therapy ; Drugs ; Female ; Humans ; Laboratories ; Male ; Medical records ; Middle Aged ; Multi-drug resistant tuberculosis ; Multidrug resistant organisms ; Mycobacterium tuberculosis - drug effects ; Mycobacterium tuberculosis - pathogenicity ; Patient outcomes ; Patients ; Public health ; Studies ; Treatment Outcome ; Tuberculosis ; Tuberculosis - drug therapy ; Tuberculosis - microbiology ; Tuberculosis, Multidrug-Resistant - drug therapy ; Tuberculosis, Multidrug-Resistant - microbiology
É parte de: BMC infectious diseases, 2017-08, Vol.17 (1), p.571-571, Article 571
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Descrição: The implementation of rapid drug susceptibility testing (DST) is a current global priority for TB control. However, data are scarce on patient-relevant outcomes for presumptive diagnosis of drug-resistant tuberculosis (pDR-TB) evaluated under field conditions in high burden countries. Observational study of pDR-TB patients referred by primary and secondary health units. TB reference centers addressing DR-TB in five cities in Brazil. Patients age 18 years and older were eligible if pDR-TB, culture positive results for Mycobacterium tuberculosis and, if no prior DST results from another laboratory were used by a physician to start anti-TB treatment. The outcome measures were median time from triage to initiating appropriate anti-TB treatment, empirical treatment and, the treatment outcomes. Between February,16th, 2011 and February, 15th, 2012, among 175 pDR TB cases, 110 (63.0%) confirmed TB cases with DST results were enrolled. Among study participants, 72 (65.5%) were male and 62 (56.4%) aged 26 to 45 years. At triage, empirical treatment was given to 106 (96.0%) subjects. Among those, 85 were treated with first line drugs and 21 with second line. Median time for DST results was 69.5 [interquartile - IQR: 35.7-111.0] days and, for initiating appropriate anti-TB treatment, the median time was 1.0 (IQR: 0-41.2) days. Among 95 patients that were followed-up during the first 6 month period, 24 (25.3%; IC: 17.5%-34.9%) changed or initiated the treatment after DST results: 16/29 MDRTB, 5/21 DR-TB and 3/45 DS-TB cases. Comparing the treatment outcome to DS-TB cases, MDRTB had higher proportions changing or initiating treatment after DST results (p = 0.01) and favorable outcomes (p = 0.07). This study shows a high rate of empirical treatment and long delay for DST results. Strategies to speed up the detection and early treatment of drug resistant TB should be prioritized.
Editor: England: BioMed Central Ltd
Idioma: Inglês

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Outcomes from patients with presumed drug resistant tuberculosis in five reference centers in Brazil

Ramalho, D M P ; Miranda, P F C ; Andrade, M K ; Brígido, T ; Dalcolmo, M P ; Mesquita, E ; Dias, C F ; Gambirasio, A N ; Ueleres Braga, J ; Detjen, A ; Phillips, P P J ; Langley, I ; Fujiwara, P I ; Squire, S B ; Oliveira, M M ; Kritski, A L

England: BioMed Central Ltd

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