Evidence-based Definition for Extensively Drug-Resistant Tuberculosis

• DOI: 10.1164/rccm.202009-3527oc
• Publication Date: 2021-06-09T23:12:03Z
• Authors: Maroussia Roelens; Giovanni Battista...; Liudmila Rozanova; Janne Estill; Jonathon R. Campbell; J. Peter Cegielski; Simon Tiberi; Domingo Palmero; Greg J. Fox; Lorenzo Guglielmetti; Giovanni Sotgiu; James C. M. Brust; Didi Bang; Christian Lienhardt; Christoph Lange; Dick Menzies; Olivia Keiser; Mario Raviglione
• Keywords: Bedaquiline; Linezolid; Extensively drug-resistant tuberculosis; Regimen

Rationale: Until 2020, extensively drug-resistant tuberculosis (XDR-TB) was defined as TB with resistance to rifampicin and isoniazid (multidrug-resistant [MDR-TB]), any fluoroquinolone (FQ), second-line injectable drug (SLID). In 2019, the World Health Organization issued new recommendations for treating patients TB, substantially limiting role of SLIDs in MDR-TB treatment thus putting definition XDR-TB into question. Objectives: To propose an up-to-date XDR-TB. Methods: We used a large data set assess outcomes exposed type longer regimen. included bacteriologically confirmed known FQ SLID results. performed logistic regression estimate adjusted odds ratios (aORs) unfavorable outcome (failure, relapse, death, loss follow-up), estimates were stratified by pattern (FQ and/or SLID) group A use (moxifloxacin/levofloxacin, linezolid, bedaquiline). Measurements Main Results: 11,666 MDR-TB; 4,653 (39.9%) had outcome. Resistance FQs increased (aOR, 1.91; 95% confidence interval [CI], 1.63-2.23). Administration bedaquiline linezolid improved regardless SLIDs. Among XDR-TB, compared persons receiving no drug, aORs 0.37 (95% CI, 0.20-0.69) only, 0.40 0.21-0.77) 0.21 0.12-0.38) both. Conclusions: Our study supports additional plus helps adequacy this surveillance choice.