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Year : 2016  |  Volume : 5  |  Issue : 5  |  Page : 67

Implementation of new tools for multidrug-resistant tuberculosis detection and control


SA MRC Centre for Tuberculosis Research, DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, Division of Molecular Biology and Human Genetics, Stellenbosch University, P.O. Box 241, Cape Town 8000, South Africa

Date of Web Publication17-Feb-2017

Correspondence Address:
Robin M Warren
SA MRC Centre for Tuberculosis Research, DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, Division of Molecular Biology and Human Genetics, Stellenbosch University, P.O. Box 241, Cape Town 8000
South Africa
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Source of Support: None, Conflict of Interest: None


DOI: 10.1016/j.ijmyco.2016.08.014

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  Abstract 


Contrary to classical dogma, molecular epidemiological studies and mathematical modeling clearly show that the global drug-resistant tuberculosis (TB) epidemic is driven by transmission. Furthermore, there is mounting evidence demonstrating that amplification of resistance occurs during treatment, possibly as a result of insufficient active drugs being administered. To control the drug-resistant TB epidemic, it will be essential to implement new, rapid, and highly sensitive and specific diagnostic methods to decrease the diagnostic delay associated with culture-based testing. To date, three molecular-based diagnostic tests have been endorsed by the World Health Organization: MTBDRplus (Hain Lifescience, Nehren, Germany) Xpert MTB/RIF (Cepheid, Sunnyvale, United States) MTBDRsl (Hain Lifescience, Nehren, Germany). Implementation of the MTBDRplus assay reduced the laboratory turnaround time from 55 days to 27 days. This was further reduced to 1day with the implementation of the Xpert MTB/RIF assay. However, time to initiation of multidrug-resistant TB (MDR-TB) treatment was not significantly reduced, remaining at approximately 17 days from receipt of drug-susceptibility testing (DST) results. In an attempt to reduce the time to initiation of MDR-TB treatment, some guidelines have recommended initiating MDR-TB treatment based on the diagnosis of rifampicin resistance alone (within 5 days). However, this implies treating MDR-TB blindly until routine culture-based DST results are available (mean, 54 days). This strategy may be highly effective in countries where second-line treatment has only recently been introduced, but may have significant consequences for patients with resistance beyond MDR-TB sensu stricto. Implementation of the MTBDRsl assay promises to reduce the time for DST for fluoroquinolones and second-line injectable drugs. These tests will form the foundation for DST for the implementation of the recently recommended shortened MDR-TB regimen. The impact of the implementation of these tests on treatment outcome using either the standard or shortened MDR-TB remains to be determined.

Keywords: Tuberculosis, Drug resistance, Diagnosis


How to cite this article:
Warren RM. Implementation of new tools for multidrug-resistant tuberculosis detection and control. Int J Mycobacteriol 2016;5, Suppl S1:67

How to cite this URL:
Warren RM. Implementation of new tools for multidrug-resistant tuberculosis detection and control. Int J Mycobacteriol [serial online] 2016 [cited 2020 Sep 26];5, Suppl S1:67. Available from: http://www.ijmyco.org/text.asp?2016/5/5/67/200491




  Conflicts of interest Top


The author has no conflicts of interest to declare.





This article has been cited by
1 Effect of reliance on Xpert MTB/RIF on time to treatment and multidrug-resistant tuberculosis treatment outcomes in Tanzania: a retrospective cohort study
Edson Mollel,Isack Lekule,Lutgarde Lynen,Tom Decroo
International Health. 2019;
[Pubmed] | [DOI]



 

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