TY - JOUR
T1 - Clinical features associated with linezolid resistance among multidrug resistant tuberculosis patients at a tertiary care hospital in Mumbai, India
AU - Tornheim, J. A.
AU - Intini, E.
AU - Gupta, A.
AU - Udwadia, Z. F.
N1 - Funding Information:
JAT was supported by the National Institute of Allergy and Infectious Diseases of the National Institutes of Health (NIH NIAID awards number K23AI135102 and R21AI122922 ), the UJMT Fogarty Global Health Fellows Program ( NIH Fogarty International Center , NINDS , NIMH , NHBLI and NIEHS award number D43 TW009340 ), and the Johns Hopkins University School of Medicine Clinician Scientist Career Development Award. The content of this publication is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. The funders had no role in the design, analysis, manuscript preparation, or decision to publish this manuscript. EI was supported by the Italian Respiratory Society (SIP/IRS). The authors would like to acknowledge Prof. L Richeldi for his support of EI during her short-term scholarship at the Department of Respiratory Medicine to P.D. Hinduja Hospital and Medical Research Centre in Mumbai.
Publisher Copyright:
© 2020 The Authors
PY - 2020/8
Y1 - 2020/8
N2 - Background: Multidrug-resistant tuberculosis (MDR-TB) is an increasing problem worldwide, and 24% occurs in India. Linezolid is associated with improved MDR-TB treatment outcomes but causes significant side-effects and drug susceptibility testing (DST) is rarely available. This study assessed whether clinical factors could predict linezolid resistance. Methods: An observational cohort of adults and adolescents with MDR-TB at a tertiary care hospital in Mumbai, India was analyzed for clinical, laboratory, and radiographic findings associated with linezolid resistance. Results: In total, 343 MDR-TB patients had linezolid DST performed, and 23 (6.7%) had linezolid-resistant MDR-TB. Univariable analysis associated linezolid resistance with underweight (odds ratio (OR)–1.07, 95% confidence interval (CI):1.01–1.12); number of previous providers (OR:1.03, 95% CI:1.00–1.05); previous treatment with linezolid (OR:1.12, 95% CI:1.06–1.05), bedaquiline (OR:1.55, 95% CI:1.22–1.98), or clofazimine (OR:1.08 95% CI:1.03–1.16); cavitary disease (OR:1.10, 95% CI:1.04–1.16) and percent lung involvement (OR:1.02, 95% CI:1.01–1.03) on radiograph. DST associated linezolid resistance with resistance to fluoroquinolones (OR:1.08, 95% CI:1.01–1.14), injectables (OR:1.09, 95% CI:1.03–1.15), ethionamide (OR:1.09, 95% CI:1.03–1.15), and PAS (OR:1.13, 95% CI:1.06–1.21). In multivariate analysis, only prior linezolid and percent lung involvement were associated with linezolid resistance. Conclusion: To maximize treatment benefits while minimizing toxicity, DST remains an important tool to identify linezolid resistance.
AB - Background: Multidrug-resistant tuberculosis (MDR-TB) is an increasing problem worldwide, and 24% occurs in India. Linezolid is associated with improved MDR-TB treatment outcomes but causes significant side-effects and drug susceptibility testing (DST) is rarely available. This study assessed whether clinical factors could predict linezolid resistance. Methods: An observational cohort of adults and adolescents with MDR-TB at a tertiary care hospital in Mumbai, India was analyzed for clinical, laboratory, and radiographic findings associated with linezolid resistance. Results: In total, 343 MDR-TB patients had linezolid DST performed, and 23 (6.7%) had linezolid-resistant MDR-TB. Univariable analysis associated linezolid resistance with underweight (odds ratio (OR)–1.07, 95% confidence interval (CI):1.01–1.12); number of previous providers (OR:1.03, 95% CI:1.00–1.05); previous treatment with linezolid (OR:1.12, 95% CI:1.06–1.05), bedaquiline (OR:1.55, 95% CI:1.22–1.98), or clofazimine (OR:1.08 95% CI:1.03–1.16); cavitary disease (OR:1.10, 95% CI:1.04–1.16) and percent lung involvement (OR:1.02, 95% CI:1.01–1.03) on radiograph. DST associated linezolid resistance with resistance to fluoroquinolones (OR:1.08, 95% CI:1.01–1.14), injectables (OR:1.09, 95% CI:1.03–1.15), ethionamide (OR:1.09, 95% CI:1.03–1.15), and PAS (OR:1.13, 95% CI:1.06–1.21). In multivariate analysis, only prior linezolid and percent lung involvement were associated with linezolid resistance. Conclusion: To maximize treatment benefits while minimizing toxicity, DST remains an important tool to identify linezolid resistance.
KW - Drug resistance
KW - Drug susceptibility testing
KW - India
KW - Linezolid
KW - MDR-TB
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U2 - 10.1016/j.jctube.2020.100175
DO - 10.1016/j.jctube.2020.100175
M3 - Article
C2 - 32775702
AN - SCOPUS:85088978832
SN - 2405-5794
VL - 20
JO - Journal of Clinical Tuberculosis and Other Mycobacterial Diseases
JF - Journal of Clinical Tuberculosis and Other Mycobacterial Diseases
M1 - 100175
ER -