Improved treatment outcome of multidrug-resistant tuberculosis with the use of a rapid molecular test to detect drug resistance in China

• Published in: International journal of infectious diseases Vol. 96; pp. 390 - 397
• Main Authors: Shi, Wenpei, Davies Forsman, Lina, Hu, Yi, Zheng, Xubin, Gao, Yazhou, Li, Xuliang, Jiang, Weili, Bruchfeld, Judith, Diwan, Vinod K., Hoffner, Sven, Xu, Biao
• Format: Journal Article
• Language: English
• Published: Canada Elsevier Ltd 01-07-2020; Elsevier
• Subjects: Line probe assay (LPA); Medicin och hälsovetenskap; Molecular drug susceptibility testing; MTBDRplus/MTBDRsl; Multidrug-resistant tuberculosis (MDR-TB); Treatment outcome; Treatment outcome; Molecular drug susceptibility testing; MTBDRplus/MTBDRsl; Multidrug-resistant tuberculosis (MDR-TB); Line probe assay (LPA); molecular drug susceptibility testing; treatment outcome; line probe assay (LPA)
• ISSN: 1201-9712; 1878-3511; 1878-3511
• DOI: 10.1016/j.ijid.2020.04.049

•Molecular drug susceptibility testing (DST) significantly reduced time to multidrug-resistant tuberculosis (MDR-TB) diagnosis.•Molecular DST contributed to a decreased time to culture conversion and improved treatment outcome.•Molecular DST provided convincing evidence to better guide the MDR-TB treatment.
Numerous studies investigate the advantages of rapid molecular drug susceptibility testing (DST) in comparison to phenotypic DST, but the clinical impact on treating multi/extensively drug resistant TB(M/XDR-TB) is less studied. Therefore, we examined how molecular DST testing may improve MDR-TB treatment management and outcome in Chinese settings.
We performed a comparative study of patient cohorts before and after the implementation of molecular DST diagnosis with Genotype MTBDRsl/MTBDRplus assay in two Chinese hospitals. We collected clinical information including time to sputum culture conversion and final treatment outcome.
In total, 242 MDR-TB patients were studied including 114 before (pre-implementation group) and 128 after the implementation (post-implementation group) of molecular DST. Time to MDR-TB diagnosis was significantly reduced for patients in the post-implementation group, as compared to the pre-implementation group (median,16 vs 62 days; P < 0.001). Patients with early available molecular DST results had a more rapid culture conversion (aHR1.94 95% CI: 1.37-2.73; median,12 vs 24 months, respectively; P < 0.001) and higher rate of treatment success (68% vs 47%, P < 0.01).
The use of molecular DST in routine care for MDR-TB diagnosis as compared to phenotypic DST was associated with a decreased time to culture conversion and improved treatment outcome, highlighting its important clinical value.