Physician-initiated courtesy MODS testing for TB and MDR-TB diagnosis and patient management

• Published in: The international journal of tuberculosis and lung disease Vol. 12; no. 5; pp. 555 - 560
• Main Authors: NIC FHOGARTAIGH, C. J, VARGAS-PRADA, S, HUANCARE, V, LOPEZ, S, RODRIGUEZ, J, MOORE, D. A. J
• Format: Journal Article
• Language: English
• Published: Paris, France IUATLD 01-05-2008; Union internationale contre la tuberculose et les maladies respiratoires
• Subjects: Adolescent; Adult; Aged; Biological and medical sciences; Child; Child, Preschool; Diagnosis; Female; Health participants; Health Services Accessibility; Humans; Infant; Male; Medical sciences; Microbial Sensitivity Tests; Middle Aged; Miscellaneous; Mods; Multidrug Resistance (mdr); Mycobacterium tuberculosis; Patient Care Management; Patient Selection; Peru; Pneumology; Practice Patterns, Physicians; Prevention and actions; Public health. Hygiene; Public health. Hygiene-occupational medicine; Retrospective Studies; Time Factors; Tuberculosis; Tuberculosis - diagnosis; Tuberculosis - drug therapy; Tuberculosis, Multidrug-Resistant - diagnosis; Tuberculosis, Multidrug-Resistant - drug therapy; South America; Peru; America; Human; Treatment resistance; Health staff; tuberculosis; Physician; Patient; multidrug resistance (MDR); Medical screening; MDR tuberculosis; Clinical management; MODS; Multiple resistance; Antituberculous agent; Diagnosis; Antibacterial agent; Pneumology
• ISSN: 1027-3719; 1815-7920

SETTING: Laboratorio de Investigación de Enfermedades Infecciosas, Universidad Peruana Cayetano Heredia (UPCH) and government health centres, Lima, Peru.OBJECTIVE: To evaluate the contribution of unselected (courtesy) microscopic observation drug susceptibility (MODS) testing
to the diagnosis and/or drug susceptibility testing (DST) of tuberculosis and their subsequent impact upon patient management.DESIGN: Retrospective database analysis and case note review of MODS culture-positive cases.RESULTS: Mycobacterium tuberculosis was isolated in 28.9%
of 225 samples (209 patients); 22.2% of 63 positive cases were multidrug-resistant. In 58 MODS culture-positive cases with follow-up data available, MODS provided culture confirmation of diagnosis, DST or both in 82.8%, before any standard method. In 41.4%, this result should have prompted
a modification in patient management. Delays between laboratory result and initiation or change of treatment, where applicable, took on average 42 and 64 days, respectively, of which a delay of respectively 17 and 48 days occurred after the receipt of results by the health facility.CONCLUSION:
MODS provides important data for clinical management within a meaningful timeframe and should contribute positively to patient outcomes due to earlier initiation of appropriate therapy. Although clinicians may successfully select patients likely to benefit from MODS, ongoing work is required
to identify optimal implementation of the assay and to reduce logistical and health system derived delays.