Journal
CLINICAL INFECTIOUS DISEASES
Volume 59, Issue 11, Pages 1559-1566Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/cid/ciu631
Keywords
tuberculosis; drug-resistance; MTBDRplus; clinical outcomes
Categories
Funding
- National Institutes of Health (NIH) Fogarty International Center [D43TW007124]
- NIH National Institute of Allergy and Infectious Diseases [K23AI103044]
- Atlanta Clinical and Translational Science Institute (NIH/National Center for Advancing Translational Sciences) [UL1TR000454]
- Emory University Global Health Institute
- FOGARTY INTERNATIONAL CENTER [D43TW007124] Funding Source: NIH RePORTER
- NATIONAL CENTER FOR ADVANCING TRANSLATIONAL SCIENCES [UL1TR000454] Funding Source: NIH RePORTER
- NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES [K23AI103044] Funding Source: NIH RePORTER
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Background. There are limited data on the clinical impact of rapid diagnostic tests to detect multidrug-resistant tuberculosis (MDR-TB). We sought to determine whether the use of a molecular diagnostic test to detect MDR-TB improves clinical outcomes. Methods. A quasi-experimental study was conducted to analyze the impact of the Genotype MTBDRplus assay on clinical outcomes among patients with culture-confirmed pulmonary MDR-TB. Patients received treatment at the National Center for Tuberculosis and Lung Diseases in Tbilisi, Georgia. Time to MDR-TB treatment initiation, culture conversion, and infection control measures were compared to a time period prior to the implementation of the molecular test. Results. Of 152 MDR-TB patients, 72 (47%) were from prior to and 80 (53%) following implementation of the MTBDRplus assay (post-implementation group). Patients in the post-implementation group initiated a second-line treatment regimen more rapidly than those in the pre-implementation group (18.2 vs 83.9 days, P < .01). Among patients admitted to a drug-susceptible tuberculosis ward, those from the post-implementation group spent significantly fewer days on the drug-susceptible ward compared to patients in the pre-implementation group (10.0 vs 58.3 days, P < .01). Among patients with 24 weeks follow-up (n = 119), those in the post-implementation group had a higher rate of culture conversion at 24 weeks (86% vs 63%, P < .01) and a more rapid rate of time to culture conversion (adjusted hazard ratio [aHR] 4.15, 95% confidence interval [CI], 2.5-6.9). Conclusions. The implementation of a rapid molecular diagnostic test led to significant clinical improvements including reduced time to initiation of MDR-TB treatment, culture conversion, and improved infection control practices.
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