BACKGROUND: New approaches are needed in the treatment of multidrug-resistant and extensively drug-resistant pulmonary tuberculosis (M/XDR-PTB). We evaluated the role of adjunctive surgical therapy in the treatment of M/XDR-PTB in the setting of directly observed treatment strategy (DOTS)-Plus implementation. METHODS: We conducted an observational cohort study consisting of M/XDR-PTB patients who underwent thoracic surgery at the National Tuberculosis Center in Tbilisi, Georgia between October 2008 and February 2011. Indications for surgery included presence of M/XDR-PTB, localized pulmonary disease, fit to undergo surgery, and either medical treatment failure or such extensive drug resistance that failure was likely. Second-line anti-tuberculosis medical therapy was administered per World Health Organization (WHO) recommendations. RESULTS: Seventy-five patients (51 MDR, 24 XDR) with PTB underwent adjunctive thoracic surgery. Median age was 30 years and average duration of preoperative M/XDR-PTB medical therapy was 342 days. The following surgical procedures were performed: pneumonectomy (11%), lobectomy (54%), and segmentectomy (35%). Mean postoperative follow-up time was 372 days. Of 72 patients with evaluable outcomes, 59 (82%) had favorable outcomes including 90% of MDR and 67% of XDR-TB patients. There was no postoperative mortality; postoperative complications occurred in 7 patients (9%). Risk factors for poor treatment outcomes in univariate analysis included bilateral disease, XDR, increasing effective drugs received, positive preoperative sputum culture, and major postoperative surgical complication. CONCLUSIONS: Patients with M/XDR-PTB undergoing adjunctive thoracic surgery had high rates of favorable outcomes, no surgical-related mortality, and low rates of complications. Adjunctive surgery appears to play an important role in the treatment of select patients with M/XDR-PTB.
BACKGROUND: New approaches are needed in the treatment of multidrug-resistant and extensively drug-resistant pulmonary tuberculosis (M/XDR-PTB). We evaluated the role of adjunctive surgical therapy in the treatment of M/XDR-PTB in the setting of directly observed treatment strategy (DOTS)-Plus implementation. METHODS: We conducted an observational cohort study consisting of M/XDR-PTBpatients who underwent thoracic surgery at the National Tuberculosis Center in Tbilisi, Georgia between October 2008 and February 2011. Indications for surgery included presence of M/XDR-PTB, localized pulmonary disease, fit to undergo surgery, and either medical treatment failure or such extensive drug resistance that failure was likely. Second-line anti-tuberculosis medical therapy was administered per World Health Organization (WHO) recommendations. RESULTS: Seventy-five patients (51 MDR, 24 XDR) with PTB underwent adjunctive thoracic surgery. Median age was 30 years and average duration of preoperative M/XDR-PTB medical therapy was 342 days. The following surgical procedures were performed: pneumonectomy (11%), lobectomy (54%), and segmentectomy (35%). Mean postoperative follow-up time was 372 days. Of 72 patients with evaluable outcomes, 59 (82%) had favorable outcomes including 90% of MDR and 67% of XDR-TBpatients. There was no postoperative mortality; postoperative complications occurred in 7 patients (9%). Risk factors for poor treatment outcomes in univariate analysis included bilateral disease, XDR, increasing effective drugs received, positive preoperative sputum culture, and major postoperative surgical complication. CONCLUSIONS:Patients with M/XDR-PTB undergoing adjunctive thoracic surgery had high rates of favorable outcomes, no surgical-related mortality, and low rates of complications. Adjunctive surgery appears to play an important role in the treatment of select patients with M/XDR-PTB.
Authors: Jeffrey Phillip Jacobs; Constantine Mavroudis; Marshall Lewis Jacobs; Bohdan Maruszewski; Christo I Tchervenkov; François G Lacour-Gayet; David Robinson Clarke; Thomas Yeh; Henry L Walters; Hiromi Kurosawa; Giovanni Stellin; Tjark Ebels; Martin J Elliott Journal: Ann Thorac Surg Date: 2006-05 Impact factor: 4.330
Authors: T Törün; K Tahaoğlu; I Ozmen; T Sevim; G Ataç; A Kir; G Güngör; Y Bölükbaşi; E Maden Journal: Int J Tuberc Lung Dis Date: 2007-09 Impact factor: 2.373
Authors: Tracy Dalton; Peter Cegielski; Somsak Akksilp; Luis Asencios; Janice Campos Caoili; Sang-Nae Cho; Vladislav V Erokhin; Julia Ershova; Ma Tarcela Gler; Boris Y Kazennyy; Hee Jin Kim; Kai Kliiman; Ekaterina Kurbatova; Charlotte Kvasnovsky; Vaira Leimane; Martie van der Walt; Laura E Via; Grigory V Volchenkov; Martin A Yagui; Hyungseok Kang; Rattanawadee Akksilp; Wanlaya Sitti; Wanpen Wattanaamornkiet; Sofia N Andreevskaya; Larisa N Chernousova; Olga V Demikhova; Elena E Larionova; Tatyana G Smirnova; Irina A Vasilieva; Alena V Vorobyeva; Clifton E Barry; Ying Cai; Isdore C Shamputa; Jaime Bayona; Carmen Contreras; Cesar Bonilla; Oswaldo Jave; Jeannette Brand; Joey Lancaster; Ronel Odendaal; Michael P Chen; Lois Diem; Beverly Metchock; Kathrine Tan; Allison Taylor; Melanie Wolfgang; Eunjin Cho; Seok Yong Eum; Hyun Kyung Kwak; Jiim Lee; Jongseok Lee; Seonyeong Min; Irina Degtyareva; Evgenia S Nemtsova; Tatiana Khorosheva; Elena V Kyryanova; Grace Egos; Ma Therese C Perez; Thelma Tupasi; Soo Hee Hwang; Chang-ki Kim; Su Young Kim; Hee Jeong Lee; Liga Kuksa; Inga Norvaisha; Girts Skenders; Ingrida Sture; Tiina Kummik; Tatiana Kuznetsova; Tatiana Somova; Klavdia Levina; Gustavo Pariona; Gloria Yale; Carmen Suarez; Eddy Valencia; Piret Viiklepp Journal: Lancet Date: 2012-08-30 Impact factor: 79.321
Authors: Jose G Somocurcio; Alfredo Sotomayor; Sonya Shin; Silvia Portilla; Maria Valcarcel; Dalia Guerra; Jennifer Furin Journal: Thorax Date: 2006-08-23 Impact factor: 9.139
Authors: H J Kim; C H Kang; Y T Kim; S-W Sung; J H Kim; S M Lee; C-G Yoo; C-T Lee; Y W Kim; S K Han; Y-S Shim; J-J Yim Journal: Eur Respir J Date: 2006-05-17 Impact factor: 16.671
Authors: Gilla Kaplan; Frank A Post; Andre L Moreira; Helen Wainwright; Barry N Kreiswirth; Melike Tanverdi; Barun Mathema; Srinivas V Ramaswamy; Gabi Walther; Lafras M Steyn; Clifton E Barry; Linda-Gail Bekker Journal: Infect Immun Date: 2003-12 Impact factor: 3.441
Authors: Shama D Ahuja; David Ashkin; Monika Avendano; Rita Banerjee; Melissa Bauer; Jamie N Bayona; Mercedes C Becerra; Andrea Benedetti; Marcos Burgos; Rosella Centis; Eward D Chan; Chen-Yuan Chiang; Helen Cox; Lia D'Ambrosio; Kathy DeRiemer; Nguyen Huy Dung; Donald Enarson; Dennis Falzon; Katherine Flanagan; Jennifer Flood; Maria L Garcia-Garcia; Neel Gandhi; Reuben M Granich; Maria G Hollm-Delgado; Timothy H Holtz; Michael D Iseman; Leah G Jarlsberg; Salmaan Keshavjee; Hye-Ryoun Kim; Won-Jung Koh; Joey Lancaster; Christophe Lange; Wiel C M de Lange; Vaira Leimane; Chi Chiu Leung; Jiehui Li; Dick Menzies; Giovanni B Migliori; Sergey P Mishustin; Carole D Mitnick; Masa Narita; Philly O'Riordan; Madhukar Pai; Domingo Palmero; Seung-kyu Park; Geoffrey Pasvol; Jose Peña; Carlos Pérez-Guzmán; Maria I D Quelapio; Alfredo Ponce-de-Leon; Vija Riekstina; Jerome Robert; Sarah Royce; H Simon Schaaf; Kwonjune J Seung; Lena Shah; Tae Sun Shim; Sonya S Shin; Yuji Shiraishi; José Sifuentes-Osornio; Giovanni Sotgiu; Matthew J Strand; Payam Tabarsi; Thelma E Tupasi; Robert van Altena; Martie Van der Walt; Tjip S Van der Werf; Mario H Vargas; Pirett Viiklepp; Janice Westenhouse; Wing Wai Yew; Jae-Joon Yim Journal: PLoS Med Date: 2012-08-28 Impact factor: 11.069
Authors: Russell R Kempker; M Tobias Heinrichs; Ketino Nikolaishvili; Irina Sabulua; Nino Bablishvili; Shota Gogishvili; Zaza Avaliani; Brent P Little; Adam Bernheim; Hartmut Derendorf; Henry M Blumberg; Sergo Vashakidze; Charles A Peloquin Journal: Eur Respir J Date: 2018-02-07 Impact factor: 16.671
Authors: Russell R Kempker; Aline B Barth; Sergo Vashakidze; Ketino Nikolaishvili; Irina Sabulua; Nestani Tukvadze; Nino Bablishvili; Shota Gogishvili; Ravi Shankar P Singh; Jeannette Guarner; Hartmut Derendorf; Charles A Peloquin; Henry M Blumberg Journal: Antimicrob Agents Chemother Date: 2015-03-16 Impact factor: 5.191
Authors: Miguel Moreno-Molina; Natalia Shubladze; Iza Khurtsilava; Zaza Avaliani; Nino Bablishvili; Manuela Torres-Puente; Luis Villamayor; Andrei Gabrielian; Alex Rosenthal; Cristina Vilaplana; Sebastien Gagneux; Russell R Kempker; Sergo Vashakidze; Iñaki Comas Journal: Nat Commun Date: 2021-05-11 Impact factor: 17.694
Authors: Anvar Riskiyev; Ana Ciobanu; Arax Hovhannesyan; Kristina Akopyan; Jamshid Gadoev; Nargiza Parpieva Journal: Int J Environ Res Public Health Date: 2021-06-17 Impact factor: 3.390
Authors: Sergo A Vashakidze; Shota G Gogishvili; Ketino G Nikolaishvili; Zaza R Avaliani; Abivarma Chandrakumaran; Giorgi Sh Gogishvili; Mathew Magee; Henry M Blumberg; Russell R Kempker Journal: Eur J Cardiothorac Surg Date: 2021-12-01 Impact factor: 4.534