Clinical and operational value of the extensively drug-resistant tuberculosis definition

G. B. Migliori, G. Besozzi, E. Girardi, K. Kliiman, C. Lange, O. S. Toungoussova, G. Ferrara, D. M. Cirillo, A. Gori, A. Matteelli, A. Spanevello, L. R. Codecasa, M. C. Raviglione, J. Ortmann, D. Kirsten, S. Ruesch-Gerdes, F. Piana, M. Ferrarese, G. De Iaco, S. De LorenzoP. Troupioti, L. Fattorini, E. Iona, A. Gualano, P. De Mori, R. Centis, M. Danilovits, V. Hollo, A. Mariandyshev

Research output: Contribution to journalArticle

164 Citations (Scopus)

Abstract

Currently, no information is available on the effect of resistance/susceptibility to first-line drugs different from isoniazid and rifampicin in determining the outcome of extensively drug-resistant tuberculosis (XDR-TB) patients, and whether being XDR-TB is a more accurate indicator of poor clinical outcome than being resistant to all first-line anti-tuberculosis (TB) drugs. To investigate this issue, a large series of multidrug-resistant TB (MDR-TB) and XDR-TB cases diagnosed in Estonia, Germany, Italy and the Russian Federation during the period 1999-2006 were analysed. Drug-susceptibility testing for first- and second-line anti-TB drugs, quality assurance and treatment delivery was performed according to World Health Organization recommendations in all study sites. Out of 4,583 culture-positive TB cases analysed, 361 (7.9%) were MDR and 64 (1.4%) were XDR. XDR-TB cases had a relative risk (RR) of 1.58 to have an unfavourable outcome compared with MDR-TB cases resistant to all first-line drugs (isoniazid, rifampicin ethambutol, streptomycin and, when tested, pyrazinamide), and an RR of 2.61 compared with "other" MDR-TB cases (those susceptible to at least one first-line anti-TB drug among ethambutol, pyrazinamide and streptomycin, regardless of resistance to the second-line drugs not defining XDR-TB). The emergence of extensively drug-resistant tuberculosis confirms that problems in tuberculosis management are still present in Europe. While waiting for new tools which will facilitate management of extensively drug-resistant tuberculosis, accessibility to quality diagnostic and treatment services should be urgently ensured and adequate public health policies should be rapidly implemented to prevent further development of drug resistance. Copyright

Original languageEnglish
Pages (from-to)623-626
Number of pages4
JournalEuropean Respiratory Journal
Volume30
Issue number4
DOIs
Publication statusPublished - Oct 2007

Fingerprint

Extensively Drug-Resistant Tuberculosis
Tuberculosis
Pharmaceutical Preparations
Pyrazinamide
Ethambutol
Isoniazid
Streptomycin
Rifampin
Diagnostic Services
Estonia
Multidrug-Resistant Tuberculosis
Public Policy
Health Policy
Drug Resistance
Italy
Germany
Public Health

Keywords

  • Clinical value
  • Drug resistance
  • Extensively drug-resistant tuberculosis
  • Multidrug-resistant tuberculosis
  • Tuberculosis

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Clinical and operational value of the extensively drug-resistant tuberculosis definition. / Migliori, G. B.; Besozzi, G.; Girardi, E.; Kliiman, K.; Lange, C.; Toungoussova, O. S.; Ferrara, G.; Cirillo, D. M.; Gori, A.; Matteelli, A.; Spanevello, A.; Codecasa, L. R.; Raviglione, M. C.; Ortmann, J.; Kirsten, D.; Ruesch-Gerdes, S.; Piana, F.; Ferrarese, M.; De Iaco, G.; De Lorenzo, S.; Troupioti, P.; Fattorini, L.; Iona, E.; Gualano, A.; De Mori, P.; Centis, R.; Danilovits, M.; Hollo, V.; Mariandyshev, A.

In: European Respiratory Journal, Vol. 30, No. 4, 10.2007, p. 623-626.

Research output: Contribution to journalArticle

Migliori, GB, Besozzi, G, Girardi, E, Kliiman, K, Lange, C, Toungoussova, OS, Ferrara, G, Cirillo, DM, Gori, A, Matteelli, A, Spanevello, A, Codecasa, LR, Raviglione, MC, Ortmann, J, Kirsten, D, Ruesch-Gerdes, S, Piana, F, Ferrarese, M, De Iaco, G, De Lorenzo, S, Troupioti, P, Fattorini, L, Iona, E, Gualano, A, De Mori, P, Centis, R, Danilovits, M, Hollo, V & Mariandyshev, A 2007, 'Clinical and operational value of the extensively drug-resistant tuberculosis definition', European Respiratory Journal, vol. 30, no. 4, pp. 623-626. https://doi.org/10.1183/09031936.00077307
Migliori, G. B. ; Besozzi, G. ; Girardi, E. ; Kliiman, K. ; Lange, C. ; Toungoussova, O. S. ; Ferrara, G. ; Cirillo, D. M. ; Gori, A. ; Matteelli, A. ; Spanevello, A. ; Codecasa, L. R. ; Raviglione, M. C. ; Ortmann, J. ; Kirsten, D. ; Ruesch-Gerdes, S. ; Piana, F. ; Ferrarese, M. ; De Iaco, G. ; De Lorenzo, S. ; Troupioti, P. ; Fattorini, L. ; Iona, E. ; Gualano, A. ; De Mori, P. ; Centis, R. ; Danilovits, M. ; Hollo, V. ; Mariandyshev, A. / Clinical and operational value of the extensively drug-resistant tuberculosis definition. In: European Respiratory Journal. 2007 ; Vol. 30, No. 4. pp. 623-626.
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AU - Besozzi, G.

AU - Girardi, E.

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AU - Lange, C.

AU - Toungoussova, O. S.

AU - Ferrara, G.

AU - Cirillo, D. M.

AU - Gori, A.

AU - Matteelli, A.

AU - Spanevello, A.

AU - Codecasa, L. R.

AU - Raviglione, M. C.

AU - Ortmann, J.

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AU - Piana, F.

AU - Ferrarese, M.

AU - De Iaco, G.

AU - De Lorenzo, S.

AU - Troupioti, P.

AU - Fattorini, L.

AU - Iona, E.

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