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Time to Sputum Culture Conversion and Treatment Outcomes Among Patients with Isoniazid-Resistant Tuberculosis in Atlanta, Georgia.
- Source :
-
Clinical Infectious Diseases . Dec2017, Vol. 65 Issue 11, p1862-1871. 10p. - Publication Year :
- 2017
-
Abstract
- Background. Although isoniazid-resistant tuberculosis is more common than multidrug-resistant tuberculosis, it has been much less studied. We examined the impact of isoniazid resistance and treatment regimen, including use of a fluoroquinolone, on clinical outcomes. Methods. A retrospective cohort study among patients with sputum culture-positive tuberculosis was performed. Early fluoroquinolone (FQ) use was defined as receiving ≥5 doses during the first month of treatment. The primary outcome was time to sputum culture conversion (tSCC). A multivariate proportional hazards model was used to determine the association of isoniazid resistance with tSCC. Results. Among 236 patients with pulmonary tuberculosis, 59 (25%) had isoniazid resistance. The median tSCC was similar for isoniazid-resistant and -susceptible cases (35 vs 29 days; P = .39), and isoniazid resistance was not associated with tSCC in multivariate analysis (adjusted hazard ratio = 0.83; 95% confidence interval [CI], .59-1.17). Early FQ use was higher in isoniazid-resistant than -susceptible cases (20% vs 10%; P = .05); however, it was not significantly associated with tSCC in univariate analysis (hazard ratio = 1.48; 95% CI, .95-2.28). Patients with isoniazid-resistant tuberculosis were treated with regimens containing rifampin, pyrazinamide, and ethambutol +/- a FQ for a median of 9.7 months. Overall, 191 (83%) patients were cured. There was no difference in initial treatment outcomes; however, all cases of acquired-drug resistance (n = 1) and recurrence (n = 3) occurred among patients with isoniazid-resistant tuberculosis. Conclusions. There was no significant association with isoniazid resistance and tSCC or initial treatment outcomes. Although patients with isoniazid-resistant tuberculosis had a high cure rate, the cases of recurrence and acquired drug resistance are concerning and highlight the need for longer-term follow-up studies. [ABSTRACT FROM AUTHOR]
- Subjects :
- *DRUG therapy for tuberculosis
*FLUOROQUINOLONES
*CONFIDENCE intervals
*DRUG resistance in microorganisms
*ISONIAZID
*LONGITUDINAL method
*MICROBIAL sensitivity tests
*MULTIVARIATE analysis
*PROBABILITY theory
*SPUTUM
*STATISTICS
*TREATMENT effectiveness
*PROPORTIONAL hazards models
*RETROSPECTIVE studies
*DESCRIPTIVE statistics
*ODDS ratio
*THERAPEUTICS
Subjects
Details
- Language :
- English
- ISSN :
- 10584838
- Volume :
- 65
- Issue :
- 11
- Database :
- Academic Search Index
- Journal :
- Clinical Infectious Diseases
- Publication Type :
- Academic Journal
- Accession number :
- 126235471
- Full Text :
- https://doi.org/10.1093/cid/cix686