Silvia S Chiang1,2, Meredith B Brooks3, Helen E Jenkins4, Dana Rubenstein1, James A Seddon5,6, Brittney J van de Water3, Michael M Lindeborg3, Mercedes C Becerra3,7, Courtney M Yuen3,7. 1. Department of Pediatrics, Alpert Medical School of Brown University, Providence, Rhode Island, USA. 2. Center for International Health Research, Rhode Island Hospital, Providence, Rhode Island, USA. 3. Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA. 4. Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA. 5. Department of Infectious Diseases, Imperial College London, London, United Kingdom. 6. Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa. 7. Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Abstract
BACKGROUND: Household contacts of patients with drug-resistant tuberculosis (TB) are at high risk for being infected with Mycobacterium tuberculosis and for developing TB disease. To guide regimen composition for the empirical treatment of TB infection and disease in these household contacts, we estimated drug-resistance profile concordance between index patients with drug-resistant TB and their household contacts. METHODS: We performed a systematic review and meta-analysis of studies published through 24 July 2018 that reported resistance profiles of drug-resistant TB index cases and secondary cases within their households. Using a random-effects meta-analysis, we estimated resistance profile concordance, defined as the percentage of secondary cases whose M. tuberculosis strains were resistant to the same drugs as strains from their index cases. We also estimated isoniazid/rifampin concordance, defined as whether index and secondary cases had identical susceptibilities for isoniazid and rifampin only. RESULTS: We identified 33 eligible studies that evaluated resistance profile concordance between 484 secondary cases and their household index cases. Pooled resistance profile concordance was 54.3% (95% confidence interval [CI], 40.7-67.6%; I2 = 85%). Pooled isoniazid/rifampin concordance was 82.6% (95% CI, 72.3-90.9%; I2 = 73%). Concordance estimates were similar in a subanalysis of 16 studies from high-TB-burden countries. There were insufficient data to perform a subanalysis among pediatric secondary cases. CONCLUSIONS: Household contacts of patients with drug-resistant TB should receive treatment for TB infection and disease that assumes that they, too, are infected with a drug-resistant M. tuberculosis strain. Whenever possible, drug susceptibility testing should be performed for secondary cases to optimize regimen composition.
BACKGROUND: Household contacts of patients with drug-resistant tuberculosis (TB) are at high risk for being infected with Mycobacterium tuberculosis and for developing TB disease. To guide regimen composition for the empirical treatment of TBinfection and disease in these household contacts, we estimated drug-resistance profile concordance between index patients with drug-resistant TB and their household contacts. METHODS: We performed a systematic review and meta-analysis of studies published through 24 July 2018 that reported resistance profiles of drug-resistant TB index cases and secondary cases within their households. Using a random-effects meta-analysis, we estimated resistance profile concordance, defined as the percentage of secondary cases whose M. tuberculosis strains were resistant to the same drugs as strains from their index cases. We also estimated isoniazid/rifampin concordance, defined as whether index and secondary cases had identical susceptibilities for isoniazid and rifampin only. RESULTS: We identified 33 eligible studies that evaluated resistance profile concordance between 484 secondary cases and their household index cases. Pooled resistance profile concordance was 54.3% (95% confidence interval [CI], 40.7-67.6%; I2 = 85%). Pooled isoniazid/rifampin concordance was 82.6% (95% CI, 72.3-90.9%; I2 = 73%). Concordance estimates were similar in a subanalysis of 16 studies from high-TB-burden countries. There were insufficient data to perform a subanalysis among pediatric secondary cases. CONCLUSIONS: Household contacts of patients with drug-resistant TB should receive treatment for TBinfection and disease that assumes that they, too, are infected with a drug-resistant M. tuberculosis strain. Whenever possible, drug susceptibility testing should be performed for secondary cases to optimize regimen composition.
Authors: Peter J Dodd; Nyashadzaishe Mafirakureva; James A Seddon; Christopher F McQuaid Journal: Lancet Glob Health Date: 2022-05-18 Impact factor: 38.927
Authors: Courtney M Yuen; Ana K Millones; Jerome T Galea; Daniela Puma; Judith Jimenez; Leonid Lecca; Mercedes C Becerra; Salmaan Keshavjee Journal: BMC Public Health Date: 2021-01-11 Impact factor: 3.295
Authors: Amyn A Malik; Neel R Gandhi; Timothy L Lash; Lisa M Cranmer; Saad B Omer; Junaid F Ahmed; Sara Siddiqui; Farhana Amanullah; Aamir J Khan; Salmaan Keshavjee; Hamidah Hussain; Mercedes C Becerra Journal: Emerg Infect Dis Date: 2021-03 Impact factor: 6.883