Wednesday, August 27, 2014

Rapid MDR-TB Test Improved Clinical Outcomes

A rapid molecular diagnostic test significantly reduced the time to treatment initiation in patients with multidrug-resistant tuberculosis, new data suggest.

 “In a setting with high rates of MDR-TB, implementation of a rapid diagnostic test for drug-resistant TB into routine clinical care significantly decreased time to initiation of MDR-TB treatment, to culture conversion and improved timely cohorting of patients with MDR-TB,” the researchers wrote in Clinical Infectious Diseases.

Researchers from Emory University and the National Center for Tuberculosis Lung Diseases in Tbilisi, Republic of Georgia, conducted a quasi-experimental study of patients with sputum culture-positive MDR-TB. Georgia implemented a rapid molecular diagnostic test, the MTBDRplus assay, in 2009-2010. The researchers compared the clinical outcomes of 80 patients diagnosed with MDR-TB after the test’s implementation with the clinical outcomes of 72 patients diagnosed by conventional culture and drug-susceptibility testing before the rapid test implementation.

Patients in the pre-implementation group had a longer delay to start a second-line drug regimen (83.9 days) than the post-implementation group (18.2 days). Although all 152 patients were hospitalized and placed in a drug-resistant TB ward, 39 patients were hospitalized before their drug-resistant status was known. Among those 39 patients, people in the pre-implementation group spent 58.3 days in a drug-susceptible TB ward compared with patients in the post-implementation group, who spent 10 days in the ward.

The study included 119 patients with at least 24 weeks of follow-up time, and among those, 82% achieved sputum conversion and 73% achieved culture conversion by 6 months. Patients in the post-implementation group were more likely to have culture conversion by 24 weeks compared with patients in the pre-implementation group: 86% vs. 63%. There also was higher, but nonsignificant, rates of smear conversion in the post-implementation group.

“These findings are some of the first to demonstrate improved clinical outcomes following implementation of a rapid molecular diagnostic test to detect drug-resistant TB,” the researchers wrote. “Other National TB Programs in low- and middle-income countries, especially those with high rates of drug-resistant TB, should explore implementation of such a test in order to improve patient care and enhance TB infection control efforts.”


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