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

Abstract

MDR-TB is present in all EU countries, posing serious challenges for public health/clinical management.
The survey describes the preliminary findings in 3 EU countries, representing different TB/MDR-TB prevalence settings: low TB/low MDR-TB high TB/intermediate MDR-TB. A standardized e-tool was developed to analyze the potential critical gaps in case management that could pose a threat in fuelling further emergence of drug resistance. The tool allowed comparison of data describing management practices with international standards of TB care.
After training, 3 expert teams evaluated the original clinical records of 120 (40 per country) culture-confirmed cases: 12 XDR-TB (10%), 73 MDR-TB (60.8%) and 35 non MDR/XDR-TB (29.2%) cases.
The majority of patients were male (87/120, 72.3%); mean (±SD) age at admission was 41 (± 16) years.
Of 120 cases analyzed, 38 were cured (31.7%), 2 completed anti-TB treatment (1.7%), 8 died (6.7%), 7 defaulted (5.8%), 1 failed (0.8%) while 64 were transferred out (53.3%) with no outcome information available at the specialised centre initiating treatment.
The TB regimen and duration were not in accordance with current recommendations in 10% (12/120), and 18.3% (22/120), respectively. The dosage of anti-TB drugs was incorrect in 12.5% (15/120) patients. Environmental infection control measures (e.g., use of surgical masks, admission in isolation and negative pressure ventilation rooms) were insufficient in (80/120, 66.7%), particularly in low TB/low MDR-TB countries.
Availability of outcomes, communication between clinical and public health services, infection control measures, and treatment management as the key areas to be improved to prevent further development of drug resistance in EU.

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A. Facchini, L. D‘Ambrosio, G. Sotgiu, G. Guenther, J. P. Zellweger, G. Bothamley, R. Centis, R. Muetterlein, S. De Lorenzo, M. Villar, K. Kliiman, V. Spinu, C. Lange, D. Manissero, G. B. Migliori, TBNET Tuberculosis Network European Trialsgroup (Tradate, Sassari, Sondalo, Italy; , Germany; Berne, Switzerland; London, United Kingdom; Lisbon, Portugal; Tartu, Estonia; Bucharest, Romania; Stockholm, Sweden). Is management of MDR-/XDR-TB in Europe adequate? A TBNET survey. Eur Respir J 2010; 36: Suppl. 54, 349

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