Bacterial risk factors for treatment failure and relapse among patients with isoniazid resistant tuberculosis

Bacterial risk factors for treatment failure and relapse among patients with isoniazid resistant tuberculosis

Drug resistant tuberculosis (TB) is increasing in prevalence worldwide. Treatment failure and relapse is known to be high for patients with isoniazid resistant TB treated with standard first line regimens. However, risk factors for unfavourable outcomes and the optimal treatment regimen for isoniazi...

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Published in:BMC infectious diseases Vol. 18; no. 1; p. 112
Main Authors: Thai, Phan Vuong Khac, Ha, Dang Thi Minh, Hanh, Nguyen Thi, Day, Jeremy, Dunstan, Sarah, Nhu, Nguyen Thi Quynh, Kiet, Vo Sy, Lan, Nguyen Huu, Dung, Nguyen Huy, Lan, Nguyen Thi Ngoc, Thuong, Nguyen Thuong, Lan, Nguyen Ngoc, Liễu, Phạm Thị Thúy, Hồng, Nguyễn Thị, Điệp, Đào Công, Thanh, Nguyễn Thị Kim, Hội, Nguyễn Văn, Nghĩa, Nguyễn Văn, Đại, Trương Ngọc, Minh, Hoàng Quang, Thơm, Nguyễn Văn, Farrar, Jeremy, Caws, Maxine
Format: Journal Article
Language:English
Published: England BioMed Central Ltd 06-03-2018
BioMed Central
BMC
Subjects:
Adolescent
Adult
Analysis
Antitubercular Agents - therapeutic use
Cohort Studies
Complications and side effects
Dosage and administration
Drug resistance
Drug therapy
Female
Humans
Isoniazid
Isoniazid - therapeutic use
Male
Middle Aged
Multidrug resistance
Mycobacterium tuberculosis - drug effects
Mycobacterium tuberculosis - genetics
Recurrence
Resistance
Rifampin - therapeutic use
Risk Factors
Sputum - microbiology
Treatment
Treatment Failure
Treatment outcome
Tuberculosis
Tuberculosis, Multidrug-Resistant - drug therapy
Tuberculosis, Pulmonary - drug therapy
Vietnam
Young Adult
Resistance
Treatment
Tuberculosis
Isoniazid
Multidrug resistance
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Summary:Drug resistant tuberculosis (TB) is increasing in prevalence worldwide. Treatment failure and relapse is known to be high for patients with isoniazid resistant TB treated with standard first line regimens. However, risk factors for unfavourable outcomes and the optimal treatment regimen for isoniazid resistant TB are unknown. This cohort study was conducted when Vietnam used the eight month first line treatment regimen and examined risk factors for failure/relapse among patients with isoniazid resistant TB. Between December 2008 and June 2011 2090 consecutive HIV-negative adults (≥18 years of age) with new smear positive pulmonary TB presenting at participating district TB units in Ho Chi Minh City were recruited. Participants with isoniazid resistant TB identified by Microscopic Observation Drug Susceptibility (MODS) had extended follow-up for 2 years with mycobacterial culture to test for relapse. MGIT drug susceptibility testing confirmed 239 participants with isoniazid resistant, rifampicin susceptible TB. Bacterial and demographic factors were analysed for association with treatment failure and relapse. Using only routine programmatic sputum smear microscopy for assessment, (months 2, 5 and 8) 30/239 (12.6%) had an unfavourable outcome by WHO criteria. Thirty-nine patients were additionally detected with unfavourable outcomes during 2 year follow up, giving a total of 69/239 (28.9%) of isoniazid (INH) resistant cases with unfavourable outcome by 2 years of follow-up. Beijing lineage was the only factor significantly associated with unfavourable outcome among INH-resistant TB cases during 2 years of follow-up. (adjusted OR = 3.16 [1.54-6.47], P = 0.002). One third of isoniazid resistant TB cases suffered failure/relapse within 2 years under the old eight month regimen. Over half of these cases were not identified by standard WHO recommended treatment monitoring. Intensified research on early identification and optimal regimens for isoniazid resistant TB is needed. Infection with Beijing genotype of TB is a significant risk factor for bacterial persistence on treatment resulting in failure/relapse within 2 years. The underlying mechanism of increased tolerance for standard drug regimens in Beijing genotype strains remains unknown.
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ISSN:1471-2334
1471-2334
DOI:10.1186/s12879-018-3033-9