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Minimum Inhibitory ...
Minimum Inhibitory Concentrations of Fluoroquinolones and Pyrazinamide Susceptibility Correlate to Clinical Improvement in Multidrug-resistant Tuberculosis Patients: A Nationwide Swedish Cohort Study Over 2 Decades
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- Davies Forsman, Lina (author)
- Karolinska Institutet,Karolinska Inst, Sweden; Karolinska Univ Hosp Solna, Sweden
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- Jonsson, Jerker (author)
- Karolinska Institutet,Karolinska Inst, Sweden; Publ Hlth Agcy Sweden, Sweden
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- Wagrell, Charlotta (author)
- Karolinska Inst, Sweden
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- Werngren, Jim (author)
- Publ Hlth Agcy Sweden, Sweden
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- Mansjo, Mikael (author)
- Publ Hlth Agcy Sweden, Sweden
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- Wijkander, Maria (author)
- Publ Hlth Agcy Sweden, Sweden
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- Groenheit, Ramona (author)
- Publ Hlth Agcy Sweden, Sweden
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- Hammar, Ulf (author)
- Karolinska Inst, Sweden
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- Giske, Christian G. (author)
- Karolinska Institutet,Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden
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- Schön, Thomas (author)
- Linköpings universitet,Avdelningen för mikrobiologi, infektion och inflammation,Medicinska fakulteten,Kalmar Cty Hosp, Sweden
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- Bruchfeld, Judith (author)
- Karolinska Inst, Sweden; Karolinska Univ Hosp Solna, Sweden
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(creator_code:org_t)
- 2018-12-18
- 2019
- English.
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In: Clinical Infectious Diseases. - : OXFORD UNIV PRESS INC. - 1058-4838 .- 1537-6591. ; 69:8, s. 1394-1402
- Related links:
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
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- Background. Minimum inhibitory concentration (MIC) testing, unlike routine drug susceptibility testing (DST) at a single critical concentration, quantifies drug resistance. The association of MICs and treatment outcome in multidrug-resistant (MDR)-tuberculosis patients is unclear. Therefore, we correlated MICs of first- and second-line tuberculosis drugs with time to sputum culture conversion (tSCC) and treatment outcome in MDR-tuberculosis patients. Methods. Clinical and demographic data of MDR-tuberculosis patients in Sweden, including DST results, were retrieved from medical records from 1992 to 2014. MIC determinations were performed retrospectively for the stored individual Mycobacterium tuberculosis (Mtb) isolates using broth microdilution in Middlebrook 7H9. We fitted Cox proportional hazard models correlating MICs, DST results, and clinical variables to tSCC and treatment outcome. Results. Successful treatment outcome was observed in 83.5% (132/158) of MDR-tuberculosis patients. Increasing MICs of fluoroquinolones, diabetes, and age amp;gt;40 years were significantly associated with unsuccessful treatment outcome. Patients treated with pyrazinamide (PZA) had a significantly shorter tSCC compared to patients who were not (median difference, 27 days). Conclusions. Increasing MICs of fluoroquinolones were correlated with unsuccessful treatment outcome in MDR-tuberculosis patients. Further studies, including MIC testing and clinical outcome data to define clinical Mtb breakpoints, are warranted. PZA treatment was associated with shorter tSCC, highlighting the importance of PZA DST.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Infektionsmedicin (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Infectious Medicine (hsv//eng)
Keyword
- treatment outcome; drug-resistant tuberculosis; cohort study; drug regimen; pyrazinamide
Publication and Content Type
- ref (subject category)
- art (subject category)
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- By the author/editor
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Davies Forsman, ...
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Jonsson, Jerker
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Wagrell, Charlot ...
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Werngren, Jim
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Mansjo, Mikael
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Wijkander, Maria
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Groenheit, Ramon ...
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Hammar, Ulf
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Giske, Christian ...
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Schön, Thomas
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Bruchfeld, Judit ...
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- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Infectious Medic ...
- Articles in the publication
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Clinical Infecti ...
- By the university
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Linköping University
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Karolinska Institutet