Molecular detection of isoniazid monoresistance improves tuberculosis treatment: A retrospective cohort in France. Issue 1 (July 2022)

• Record Type: Journal Article
• Authors: Bachir, Marwa; Guglielmetti, Lorenzo; Tunesi, Simone; Billard-Pomares, Typhaine; Chiesi, Sheila; Jaffré, Jérémy; Langris, Hugo; Pourcher, Valérie; Schramm, Frédéric; Lemaître, Nadine; Robert, Jérôme
• Is Part Of: Journal of infection. Volume 85:Issue 1(2022)
• Page Start: 24
• Page End: 30
• Publication Date: 2022-07
• Subjects: Tuberculosis -- Isoniazid -- Drug resistance -- Epidemiology -- France; Infection -- Periodicals; Bacterial Infections -- Periodicals; Communicable Diseases -- Periodicals; Electronic journals; 616.905
• DOI: 10.1016/j.jinf.2022.05.017
• Languages: English
• ISSNs: 0163-4453

Abstract

Highlights: Less than 25% of isoniazid-resistant-TB are diagnosed at an early stage in France. Early diagnosis of isoniazid resistance shortens time to adequate treatment. Adequate treatment of isoniazid-resistant-TB improves treatment outcome. Summary: Objectives: Isoniazid-monoresistant tuberculosis (HR-TB) requires early diagnosis and adapted treatment to achieve optimal outcomes. The primary aim of the study was to assess the impact of the implementation of rapid diagnostic tests on HR-TB treatment in France. Methods: We designed a retrospective multicentre study including consecutive HR-TB patients diagnosed in 2016 and 2017. Implementation of a molecular assay detecting isoniazid resistance directly on a clinical sample was recorded. The association between early implementation of such assays and adequate treatment was assessed by a multivariable Cox proportional hazards model. Results: Overall, 99 HR-TB patients were included from 20 University Hospitals. Among all smear-positive HR-TB patients, only 26% beneficiated from early molecular HR detection. This detection was independently associated with shorter time to adequate treatment (HR = 2.0 [1.1–3.8], p = 0.03). Conclusion: In our study, molecular detection of HR on an initial sample was independently associated with earlier treatment adaptation.