Source: Annual Congress 2010 - Multidrug-resistant and extensively drug-resistant tuberculosis
Disease area: Respiratory infections

Abstract

No standardized tool is available to survey the key factor responsible for the emergence of multidrug-resistance: inappropriate TB case management.
This study describes the process undertaken by TBNET and ECDC to develop a standardized tool to survey MDR-/XDR-TB case management in the European Union countries.
It was devised to survey original clinical records of cases to ascertain if case management activities were performed according to established guidelines.
Development included three reviews by a core group of experts, two phases of pre-testing and desk simulations. Scores were assigned through a Delphi process aimed at defining a specific weight (expressing the importance) for each data element. The tool is composed of three parts and one annex: Part 1 summarizes the features of the setting surveyed (62 items); Part 2 collects information on individual clinical records surveyed (one line per clinical case, 141 items); Part 3 allows comparison of the key case management decisions taken on each individual case against internationally agreed standards (25 questions).
The simulation using as pre-test identified two "major" deviations from internationally agreed standards in the area of infection control (no negative pressure ventilation available, no respirator fit testing done) and the impossibility to perform all second-line DST at the Reference Centre (capreomycin) as well as three "major" deviations related to drug choice and two "critical" ones related to the diagnostic algorithm in hospitals managing MDR-TB cases before referring them to a Reference Centre.
The tool identifies the most critical case management gaps to be addressed urgently to prevent further emergence of drug resistance.

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G. Sotgiu, R. Centis, L. D‘Ambrosio, S. De Lorenzo, M. D. Richardson, A. Facchini, C. Lange, D. Manissero, G. B. Migliori, TBNET Tubeculosis Network European Trialsgroup (Sassari, Tradate, Sondalo, Italy; Seattle, United States Of America; , Germany; Stockholm, Sweden). Development of a standardized tool to survey MDR-/XDR-TB case management in Europe. Eur Respir J 2010; 36: Suppl. 54, 348

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