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@article{Zürcher:2019:10.1016/S1473-3099(18)30673-X,
author = {Zürcher, K and Ballif, M and Fenner, L and Borrell, S and Keller, PM and Gnokoro, J and Marcy, O and Yotebieng, M and Diero, L and Carter, EJ and Rockwood, N and Wilkinson, RJ and Cox, HS and Ezati, N and Abimiku, A and Collantes, J and Avihingsanon, A and Kawkitinarong, K and Reinhard, M and Hömke, R and Huebner, R and Gagneux, S and Böttger, E and Egger, M},
doi = {10.1016/S1473-3099(18)30673-X},
journal = {Lancet Infectious Diseases},
pages = {298--307},
title = {Drug susceptibility testing and mortality in patients treated for tuberculosis in high-burden countries: A multi-centre cohort study},
url = {http://dx.doi.org/10.1016/S1473-3099(18)30673-X},
volume = {19},
year = {2019}
}

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TY  - JOUR
AB  - Background: Drug resistance is a challenge for the global control of tuberculosis. We examined mortality in tuberculosis patients from high-burden countries, according to concordance or discordance of results from drug susceptibility testing (DST) done locally and in a reference laboratory.Methods: We collected Mycobacterium tuberculosis isolates from adult patients in Côte d’Ivoire, Democratic Republic of the Congo, Kenya, Nigeria, South Africa, Peru, and Thailand, stratified by HIV status and tuberculosis drug resistance. Molecular or phenotypic drug susceptibility testing (DST) was done locally and at the Swiss tuberculosis reference laboratory. We examined mortality during treatment according to DST results and treatment adequacy in logistic regression models adjusting for sex, age, sputum microscopy and HIV status.Findings: 634 tuberculosis patients were included; median age was 33.2 years, 239 (37.7%) were female, 272 (42.9%) HIV-positive and 69 (10.9%) patients died. Based on the reference laboratory DST, 394 (62.2%) strains were pan-susceptible, 45 (7.1%) mono-resistant, 163 (25.7%) multidrug-resistant (MDR-TB), and 30 (4.7%) had preextensive or extensive drug resistance (pre-XDR/XDR-TB). Results of reference and local laboratories were discordant in 121 (19.1%) cases. Overall, sensitivity and specificity to detect any resistance were 90.8% and 84.3%, respectively. Mortalityranged from 6.0% (20/336) in patients with pan-susceptible tuberculosis treated according to WHO guidelines to 57.1% (8/14) in patients with resistant strains who were under treated. In logistic regression, compared to concordant DST results, the adjusted odds ratio of death was 7.33 (95% CI 2.70-19.95) for patients with discordant results potentially leading to under treatment. Interpretation: Inaccurate DST by comparison to a reference standard led to under treatment of drug resistant tuberculosis and increased mortality. Rapid molecular DST of first- and second-line drugs a
AU  - Zürcher,K
AU  - Ballif,M
AU  - Fenner,L
AU  - Borrell,S
AU  - Keller,PM
AU  - Gnokoro,J
AU  - Marcy,O
AU  - Yotebieng,M
AU  - Diero,L
AU  - Carter,EJ
AU  - Rockwood,N
AU  - Wilkinson,RJ
AU  - Cox,HS
AU  - Ezati,N
AU  - Abimiku,A
AU  - Collantes,J
AU  - Avihingsanon,A
AU  - Kawkitinarong,K
AU  - Reinhard,M
AU  - Hömke,R
AU  - Huebner,R
AU  - Gagneux,S
AU  - Böttger,E
AU  - Egger,M
DO  - 10.1016/S1473-3099(18)30673-X
EP  - 307
PY  - 2019///
SN  - 1473-3099
SP  - 298
TI  - Drug susceptibility testing and mortality in patients treated for tuberculosis in high-burden countries: A multi-centre cohort study
T2  - Lancet Infectious Diseases
UR  - http://dx.doi.org/10.1016/S1473-3099(18)30673-X
UR  - http://hdl.handle.net/10044/1/65844
VL  - 19
ER  -

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