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Sökning: onr:"swepub:oai:DiVA.org:liu-173446" > Genotypic resistanc...

Genotypic resistance of pyrazinamide but not MIC is associated with longer time to sputum culture conversion in patients with multidrug-resistant tuberculosis

Kuhlin, Johanna (författare)
Department of Medicine Solna, Division of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
Davies Forsman, Lina (författare)
Department of Medicine Solna, Division of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
Mansjö, Mikael (författare)
Department of Microbiology, Public Health Agency of Sweden, Stockholm, Sweden
visa fler...
Jonsson Nordvall, Michaela (författare)
Linköpings universitet,Avdelningen för inflammation och infektion,Medicinska fakulteten,Region Östergötland, Klinisk mikrobiologi
Wijkander, Maria (författare)
Department of Microbiology, Public Health Agency of Sweden, Stockholm, Sweden
Wagrell, Charlotta (författare)
Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
Jonsson, Jerker (författare)
Department of Public Health Analysis and Data Management, Public Health Agency of Sweden, Stockholm, Sweden
Groenheit, Ramona (författare)
Department of Microbiology, Public Health Agency of Sweden, Stockholm, Sweden
Werngren, Jim (författare)
Department of Microbiology, Public Health Agency of Sweden, Stockholm, Sweden
Schön, Thomas, 1973- (författare)
Linköpings universitet,Avdelningen för inflammation och infektion,Medicinska fakulteten,Region Östergötland, Infektionskliniken i Östergötland,Department of Infectious Diseases and Clinical Microbiology, Kalmar County Hospital, Kalmar, Sweden
Bruchfeld, Judith (författare)
Department of Medicine Solna, Division of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
visa färre...
 (creator_code:org_t)
2020-10-03
2021
Engelska.
Ingår i: Clinical Infectious Diseases. - : Oxford University Press. - 1058-4838 .- 1537-6591. ; 73:9, s. E3511-E3517
  • Tidskriftsartikel (refereegranskat)
Abstract Ämnesord
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  • BACKGROUND: PZA resistance in multidrug-resistant tuberculosis (MDR-TB) is common and it is not clear how it affects interim and treatment outcomes. Although rarely performed, phenotypic drug susceptibility testing (pDST) is used to define PZA resistance but genotypic DST (gDST) and minimum inhibitory concentration (MIC) could be beneficial. We aimed to assess the impact of PZA gDST and MIC on time to sputum culture conversion (SCC) and treatment outcome in patients with MDR-TB.METHODS: Clinical, microbiological and treatment data was collected in this cohort study for all patients diagnosed with MDR-TB in Sweden 1992-2014. MIC, pDST and whole genome sequencing of the pncA, rpsA and panD genes were used to define PZA resistance. A Cox regression model was used for statistical analyses.RESULTS: Of 157 patients with MDR-TB, 56.1% (n=88) had PZA resistant strains and 49.7% (n=78) were treated with PZA. In crude and adjusted analyses, PZA gDST resistance was associated with a 29-day longer time to SCC (hazard ratio [HR] 0.57, 95% confidence interval [CI] 0.36-0.89, p=0.013 and HR 0.49, 95% CI 0.29-0.82, p=0.007, respectively). A two-fold decrease in dilutions of PZA MIC for PZA susceptible strains showed no association with SCC in crude or adjusted analyses (HR 0.98, 95% CI 0.73-1.31, p=0.89). Genotypic DST and MIC for PZA were not associated with treatment outcome.CONCLUSION: In patients with MDR-TB, gDST PZA resistance was associated with a longer time to SCC. Rapid PZA gDST is important to identify patients who may benefit from PZA treatment.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Infektionsmedicin (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Infectious Medicine (hsv//eng)

Nyckelord

MDR-TB
PZA
minimum inhibitory concentration
pncA gene
treatment outcome

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