Increasing Drug Resistance in Extensively Drug-Resistant Tuberculosis in South Africa
Author Information
Author(s): N.S. Shah, J. Richardson, P. Moodley, S. Moodley, P. Babaria, M. Ramtahal, S.K. Heysell, X. Li, A.P. Moll, G. Friedland, A.W. Sturm, N.R. Gandhi
Primary Institution: Albert Einstein College of Medicine
Hypothesis
We sought to further characterize second-line TB drug resistance among XDR TB isolates in Tugela Ferry by expanding DST to include capreomycin and ethionamide.
Conclusion
Resistance to 8 first-line and second-line drugs is the predominant pattern for XDR TB in Tugela Ferry, severely limiting effective therapeutic options.
Supporting Evidence
- Of 19 patients with extensively drug-resistant TB, 13 (68%) had isolates resistant to all 8 drugs tested.
- Continuous drug resistance surveillance has been implemented in Tugela Ferry, where >90% of patients are co-infected with HIV.
- Among 13 XDR TB patients with 8-drug resistance, 7 (54%) died within a median time of 59 days.
Takeaway
This study found that many patients with a severe form of tuberculosis called XDR TB are resistant to almost all available treatments, making it very hard to help them get better.
Methodology
A prospective cross-sectional study was conducted to identify patients with suspected TB and perform drug susceptibility testing on their samples.
Limitations
The reliability of second-line DST is variable, and the absolute number of XDR TB cases was low, limiting conclusions about treatment outcomes.
Participant Demographics
Of the 13 patients with 8-drug resistance XDR TB, 5 were women with a median age of 33.5 years, and 12 were HIV positive.
Digital Object Identifier (DOI)
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