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Outcomes of pulmonary tuberculosis in patients with discordant phenotypic isoniazid resistance testing.

Abstract：

INTRODUCTION:The discrepancy rates of drug susceptibility testing (DST) results between solid and liquid media have been reported to range from 2.4 to 7.4% for isoniazid. Most isolate with isoniazid DST discrepancies between solid and liquid media test as susceptible on solid medium and resistant in liquid medium, however, the optimal management of patients with discordant testing is unknown. This study was conducted to evaluate the effect of treatment regimen on treatment outcomes when patients with rifampicin-susceptible pulmonary tuberculosis have isoniazid resistance (INH-R) in liquid medium but isoniazid susceptibility (INH-S) on solid medium. METHOD:This study was retrospectively conducted by reviewing patient medical records on the liquid compared to solid culture based phenotypic testing at Samsung Medical Center between January 2009 and December 2015. The study population which have INH-R in liquid medium and INH-S on solid medium was divided into two groups: group A (n = 30), which included patients treated for INH-S tuberculosis by discontinuing pyrazinamide (and ethambutol), and group B (n = 56), which included patients treated for INH-R tuberculosis by continuing pyrazinamide and/or adding fluoroquinolone. Unfavorable outcomes included treatment failure and relapse. RESULTS:There were no statistically significant differences between the two groups including demographic data, comorbidities, radiologic data, and treatment duration. However, baseline smear positive rates were more frequent in group A (19/30, 63.3%) than in group B (22/56, 39.3%; P = 0.033). Only three patients had unfavorable outcomes; one was bacteriologically proven treatment failure and the other two were clinically judged as unfavorable outcomes. All of them were in the group A (3/30, 10%); no unfavorable outcomes occurred in the group B (0/56, 0%; P = 0.040). CONCLUSIONS:Unfavorable outcomes were less frequent in the group B than in the group A, indicating that treatment regimen modification according to DST results on liquid medium could improve treatment outcomes in patients with rifampicin-susceptible pulmonary tuberculosis. Further studies are required to confirm these findings to overcome the small number of unfavorable outcomes.

journal_name

Respir Med

journal_title

Respiratory medicine

authors

Kim S,Lee H,Park HY,Jeon K,Huh HJ,Lee NY,Jeong BH

doi

10.1016/j.rmed.2017.11.004

subject

Has Abstract

pub_date

2017-12-01 00:00:00

pages

6-11

eissn

0954-6111

issn

1532-3064

pii

S0954-6111(17)30371-2

journal_volume

133

pub_type

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Outcomes of pulmonary tuberculosis in patients with discordant phenotypic isoniazid resistance testing.