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      Multidrug-resistant tuberculosis in côte d'ivoire from 1995 to 2016: Results of national surveys

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          Abstract

          Setting: Tuberculosis (TB) drug resistance survey was conducted in 2016–2017 to estimate the burden of drug-resistant TB in Côte d'Ivoire.

          Design: A cross-sectional cluster-based survey was conducted. All eligible smear positive patients were interviewed using a structured questionnaire to collect clinical and sociodemographic information and tested by the Xpert Mycobacterium tuberculosis/rifampicin (MTB/RIF) assay. If resistant to rifampicin, solid and liquid cultures were performed. Phenotypic drug susceptibility testing (DST) was conducted in liquid medium for rifampicin, isoniazid, ethambutol, streptomycin, ofloxacin, and amikacin.

          Results: Of the 1105 sputum smear positive patients enrolled, 995 new and 100 previously treated patients were positive for Mycobacterium tuberculosis complex by Xpert. Proportion of patients with rifampicin resistance was 4.6% (95% CI: 2.4–6.7) and 22% (95% CI: 13.7–30.3), respectively, for new and previously treated patients. Second-line DST results were available for most rifampicin-resistant patients. None were resistant to amikacin, only two were ofloxacin-resistant. Apart from the antecedent of previously treatment for TB, no other risk factors for rifampicin resistance were detected.

          Conclusion: Prevalence of rifampicin resistance among TB patients in Côte d'Ivoire is higher than that in other countries in the region. Surveillance of drug resistance, through an expanded GeneXpert network, and programmatic management of drug-resistant TB (PMDT) must be strengthened in Côte d'Ivoire.

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          WHO's new end TB strategy.

          Mukund Uplekar, Diana Weil, Knut Lonnroth … (2015)
          Article 0 comments Cited 248 times – based on 0 reviews     Review now
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            Rifampin resistance missed in automated liquid culture system for Mycobacterium tuberculosis isolates with specific rpoB mutations.

            M. Gumusboga, J. C. W. Rijk, Elie Nduwamahoro … (2013)
            WHO-endorsed phenotypic drug susceptibility testing (DST) methods for Mycobacterium tuberculosis are assumed to be the gold standard for identifying rifampin (RMP) resistance. However, previous results indicated that low-level, yet probably clinically relevant, RMP resistance linked to specific rpoB mutations is easily missed by some growth-based methods. We aimed to compare the level of resistance detected on Löwenstein-Jensen (LJ) medium with resistance detected by the Bactec MGIT 960 automated DST (MGIT-DST) system for various rpoB mutants. Full agreement between LJ and MGIT-DST was observed for mutations located at codons 513 (Lys or Pro) and 531 (Leu, Trp), which were always resistant by both methods. For mutations 511Pro, 516Tyr, 533Pro, 572Phe, and several 526 mutations, LJ and MGIT results were highly discordant, with MGIT-DST failing to give a result or declaring the strains susceptible. Our data show that phenotypic RMP resistance testing of M. tuberculosis is not a binary phenomenon for some rpoB mutations and that the widely used automated MGIT 960 system is prone to miss some RMP resistance-conferring mutations, while careful DST on LJ missed hardly any. Given the association of these mutations with poor clinical outcome, our findings suggest that the gold standard for rifampin resistance should be reconsidered, in order to address the present confusion caused by discrepancies between phenotypic and genotypic results. The impacts of these mutations will depend on the frequency of their occurrence, which may vary from one setting to another.
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              World Health Organization treatment guidelines for drug-resistant tuberculosis, 2016 update

              Dennis Falzon, Holger Schünemann, Elizabeth Harausz … (2017)
              Antimicrobial resistance is a major global concern. Tuberculosis (TB) strains resistant to rifampicin and other TB medicines challenge patient survival and public health. The World Health Organization (WHO) has published treatment guidelines for drug-resistant TB since 1997 and last updated them in 2016 based on reviews of aggregated and individual patient data from published and unpublished studies. An international expert panel formulated recommendations following the GRADE approach. The new WHO guidelines recommend a standardised 9–12 months shorter treatment regimen as first choice in patients with multidrug- or rifampicin-resistant TB (MDR/RR-TB) strains not resistant to fluoroquinolones or second-line injectable agents; resistance to these two classes of core second-line medicines is rapidly detectable with molecular diagnostics also approved by WHO in 2016. The composition of longer regimens for patients ineligible for the shorter regimen was modified. A first-ever meta-analysis of individual paediatric patient data allowed treatment recommendations for childhood MDR/RR-TB to be made. Delamanid is now also recommended in patients aged 6–17 years. Partial lung resection is a recommended option in MDR/RR-TB care. The 2016 revision highlighted the continued shortage of high-quality evidence and implementation research, and reiterated the need for clinical trials and best-practice studies to improve MDR/RR-TB patient treatment outcomes and strengthen policy.
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                Author and article information

                Journal
                Journal ID (publisher-id): 1886
                Title: European Journal of Microbiology and Immunology
                Abbreviated Title: EuJMI
                Publisher: Akadémiai Kiadó
                ISSN (Electronic): 2062-8633
                Publication date (Print): September 2018
                Volume: 8
                Issue: 3
                Pages: 91-94
                Affiliations
                [ 1 ]Laboratoire National de Référence de la Tuberculose, Institut Pasteur de Côte d'Ivoire
                [ 2 ] Centre de Diagnostic et de Recherche sur le Sida , Abidjan, Côte d'Ivoire
                [ 3 ] World Health Organization, Global TB Programme , Geneva, Switzerland
                [ 4 ]TB Supranational Reference Laboratory, IRCCS San Raffaele Scientific Institute , Milan, Italy
                [ 5 ] Programme National de Lutte contre la Tuberculose , Côte d'Ivoire
                Author notes
                [*]

                Corresponding author: N’GUESSAN Kouasssi Raymond; kouassinguessan@ 123456pasteur.ci , ngueskr@ 123456gmail.com

                Article
                DOI: 10.1556/1886.2018.00001
                PMC ID: 6186018
                SO-VID: 49fd0aec-a3b5-476b-87d3-3c75f7ea3329
                Copyright © © 2018 The Author(s)
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and reproduction in any medium for non-commercial purposes, provided the original author and source are credited, a link to the CC License is provided, and changes - if any - are indicated.

                History
                Date received : 24 December 2017
                Date accepted : 16 March 2018
                Page count
                Pages: 4
                Categories
                Subject: Original Research Paper

                ScienceOpen disciplines: Medicine,Immunology,Health & Social care,Microbiology & Virology,Infectious disease & Microbiology
                Keywords: drug resistance,survey,Tuberculosis,Xpert MTB/RIF,prevalence
                Data availability:
                ScienceOpen disciplines: Medicine, Immunology, Health & Social care, Microbiology & Virology, Infectious disease & Microbiology
                Keywords: drug resistance, survey, Tuberculosis, Xpert MTB/RIF, prevalence

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