Sergo A Vashakidze1,2, Shota G Gogishvili1, Ketino G Nikolaishvili1, Zaza R Avaliani1, Abivarma Chandrakumaran3, Giorgi Sh Gogishvili1, Mathew Magee4, Henry M Blumberg5, Russell R Kempker5. 1. Thoracic Surgery Department, National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia. 2. The University of Georgia, Tbilisi, Georgia. 3. Tbilisi State Medical University, Tbilisi, Georgia. 4. Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA. 5. Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia Emory University, Atlanta, GA, USA.
Abstract
OBJECTIVES: Surgical resection is recommended as adjunctive treatment for multidrug-resistant (MDR) tuberculosis (TB) in certain scenarios; however, data are limited. We sought to evaluate the impact of surgery by comparing TB outcomes among patients with cavitary disease who received medical versus combined medical and surgical treatment. METHODS: A cohort of all patients with cavitary MDR or extensively drug-resistant (XDR) TB treated in Tbilisi, Georgia, between 2008 and 2012. Patients meeting indications for surgery underwent adjunctive resection in addition to medical treatment. We compared TB outcomes (proportions achieving cure/complete) among patients who received adjunctive surgery to those who received medical treatment alone using an adjusted robust Poisson regression. RESULTS: Among 408 patients, 299 received medical treatment alone and 109 combined medical and surgical treatment. Patients in the non-surgical group were older and had higher rates of tobacco and alcohol use and bilateral disease compared to the surgical group. Patients in the surgical group had higher rates of XDR disease (28% vs 15%). Favourable outcomes were higher among the surgical versus non-surgical group cohort (76% vs 41%). After adjusting for multiple factors, the association between adjunctive resection and favourable outcome remained (adjusted risk ratio 1.6, 95% confidence interval 1.3-2.0); the relationship was also observed in secondary models that excluded patients with bilateral disease (contraindication for surgery) and patients receiving <6 months of treatment. Major postoperative complications occurred among 8 patients (7%) with no postoperative mortality. CONCLUSIONS: Adjunctive surgery is safe and may improve the effectiveness of treatment among select patients with cavitary MDR- and XDR-TB.
OBJECTIVES: Surgical resection is recommended as adjunctive treatment for multidrug-resistant (MDR) tuberculosis (TB) in certain scenarios; however, data are limited. We sought to evaluate the impact of surgery by comparing TB outcomes among patients with cavitary disease who received medical versus combined medical and surgical treatment. METHODS: A cohort of all patients with cavitary MDR or extensively drug-resistant (XDR) TB treated in Tbilisi, Georgia, between 2008 and 2012. Patients meeting indications for surgery underwent adjunctive resection in addition to medical treatment. We compared TB outcomes (proportions achieving cure/complete) among patients who received adjunctive surgery to those who received medical treatment alone using an adjusted robust Poisson regression. RESULTS: Among 408 patients, 299 received medical treatment alone and 109 combined medical and surgical treatment. Patients in the non-surgical group were older and had higher rates of tobacco and alcohol use and bilateral disease compared to the surgical group. Patients in the surgical group had higher rates of XDR disease (28% vs 15%). Favourable outcomes were higher among the surgical versus non-surgical group cohort (76% vs 41%). After adjusting for multiple factors, the association between adjunctive resection and favourable outcome remained (adjusted risk ratio 1.6, 95% confidence interval 1.3-2.0); the relationship was also observed in secondary models that excluded patients with bilateral disease (contraindication for surgery) and patients receiving <6 months of treatment. Major postoperative complications occurred among 8 patients (7%) with no postoperative mortality. CONCLUSIONS: Adjunctive surgery is safe and may improve the effectiveness of treatment among select patients with cavitary MDR- and XDR-TB.
Authors: Gregory J Fox; Carole D Mitnick; Andrea Benedetti; Edward D Chan; Mercedes Becerra; Chen-Yuan Chiang; Salmaan Keshavjee; Won-Jung Koh; Yuji Shiraishi; Piret Viiklepp; Jae-Joon Yim; Geoffrey Pasvol; Jerome Robert; Tae Sun Shim; Sonya S Shin; Dick Menzies; S Ahuja; D Ashkin; M Avendaño; R Banerjee; M Bauer; M Burgos; R Centis; F Cobelens; H Cox; L D'Ambrosio; W C M de Lange; K DeRiemer; D Enarson; D Falzon; K Flanagan; J Flood; N Gandhi; L Garcia-Garcia; R M Granich; M G Hollm-Delgado; T H Holtz; P Hopewell; M Iseman; L G Jarlsberg; H R Kim; J Lancaster; C Lange; V Leimane; C C Leung; J Li; D Menzies; G B Migliori; M Narita; E Nathanson; R Odendaal; P O'Riordan; M Pai; D Palmero; S K Park; J Pena; C Pérez-Guzmán; A Ponce-de-Leon; M I D Quelapio; H T Quy; V Riekstina; S Royce; M Salim; H S Schaaf; K J Seung; L Shah; K Shean; J Sifuentes-Osornio; G Sotgiu; M J Strand; S W Sung; P Tabarsi; T E Tupasi; M H Vargas; R van Altena; M van der Walt; T S van der Werf; J Westenhouse; W W Yew Journal: Clin Infect Dis Date: 2016-01-12 Impact factor: 9.079
Authors: Sönke Andres; Matthias Merker; Jan Heyckendorf; Barbara Kalsdorf; Rudolf Rumetshofer; Alexander Indra; Sabine Hofmann-Thiel; Harald Hoffmann; Christoph Lange; Stefan Niemann; Florian P Maurer Journal: Am J Respir Crit Care Med Date: 2020-06-15 Impact factor: 21.405
Authors: V Cox; G Brigden; R H Crespo; E Lessem; S Lynch; M L Rich; B Waning; J Furin Journal: Int J Tuberc Lung Dis Date: 2018-04-01 Impact factor: 2.373
Authors: Jansy P Sarathy; Laura E Via; Danielle Weiner; Landry Blanc; Helena Boshoff; Eliseo A Eugenin; Clifton E Barry; Véronique A Dartois Journal: Antimicrob Agents Chemother Date: 2018-01-25 Impact factor: 5.191
Authors: Scott M Irwin; Brendan Prideaux; Edward R Lyon; Matthew D Zimmerman; Elizabeth J Brooks; Christopher A Schrupp; Chao Chen; Matthew J Reichlen; Bryce C Asay; Martin I Voskuil; Eric L Nuermberger; Koen Andries; Michael A Lyons; Véronique Dartois; Anne J Lenaerts Journal: ACS Infect Dis Date: 2016-02-24 Impact factor: 5.084