Multidrug-resistant TB treatment failure detection depends on monitoring interval and microbiological method
Abstract
Debate persists about monitoring method (culture or smear) and
interval (monthly or less frequently) during treatment for
multidrug-resistant tuberculosis (MDR-TB). We analysed existing
data and estimated the effect of monitoring strategies on timing
of failure detection.
We identified studies reporting
microbiological response to MDR-TB treatment and solicited
individual patient data from authors. Frailty survival models
were used to estimate pooled relative risk of failure detection
in the last 12 months of treatment; hazard of failure using
monthly culture was the reference.
Data were obtained
for 5410 patients across 12 observational studies. During the
last 12 months of treatment, failure detection occurred in a
median of 3 months by monthly culture; failure detection was
delayed by 2, 7, and 9 months relying on bimonthly culture,
monthly smear and bimonthly smear, respectively. Risk (95% CI)
of failure detection delay resulting from monthly smear relative
to culture is 0.38 (0.34–0.42) for all patients and 0.33
(0.25–0.42) for HIV-co-infected patients.
Failure
detection is delayed by reducing the sensitivity and frequency
of the monitoring method. Monthly monitoring of sputum cultures
from patients receiving MDR-TB treatment is recommended.
Expanded laboratory capacity is needed for high-quality culture,
and for smear microscopy and rapid molecular tests.
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