[Source: Eurosurveillance, full page: (LINK). Abstract, edited.]
Isoniazid (INH) mono-resistance and tuberculosis (TB) treatment success: analysis of European surveillance data, 2002 to 2014
Basel Karo1,2,3,4, Anke Kohlenberg4,5, Vahur Hollo5, Raquel Duarte6, Lena Fiebig33,7, Sarah Jackson8, Cathriona Kearns9, Csaba Ködmön5, Maria Korzeniewska-Kosela 10, Dimitrios Papaventsis11, Ivan Solovic12, Dick van Soolingen13, Marieke J. van der Werf5
Affiliations: 1 EPIET: European Programme of Intervention Epidemiology Training, European Centre for Disease Prevention and Control, Stockholm, Sweden; 2 Field Epidemiology South East & London, National infection Service, Public Health England, London, United Kingdom; 3 Infectious Disease Department, Robert Koch Institute, Berlin, Germany; 4 These authors contributed equally to this article and share first authorship; 5 European Centre for Disease Prevention and Control, Stockholm, Sweden; 6 Directorate General of Health, Lisbon, Portugal; 7 Apopo, Sokoine University of Agriculture, Morogoro, Tanzania; 8 Health Protection Surveillance Centre, Dublin, Ireland; 9 Public Health Agency, Belfast, Northern Ireland; 10 National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland; 11 National Reference Laboratory for Mycobacteria, ‘Sotiria’ Chest Diseases Hospital, Athens, Greece; 12 National Institute for TB, Lung Diseases and Thoracic Surgery, Vysne Hagy, Catholic University Ruzomberok, Ruzomberok, Slovakia; 13 Tuberculosis Reference Laboratory, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
Correspondence: Anke Kohlenberganke.kohlenbergecdc.europa.eu
Citation style for this article: Karo Basel, Kohlenberg Anke, Hollo Vahur, Duarte Raquel, Fiebig3 Lena, Jackson Sarah, Kearns Cathriona, Ködmön Csaba, Korzeniewska-Kosela Maria, Papaventsis Dimitrios, Solovic Ivan, van Soolingen Dick, van der Werf Marieke J.. Isoniazid (INH) mono-resistance and tuberculosis (TB) treatment success: analysis of European surveillance data, 2002 to 2014. Euro Surveill. 2019;24(12):pii=1800392. https://doi.org/10.2807/1560-7917.ES.2019.24.12.1800392
Received: 17 Jul 2018; Accepted: 09 Feb 2019
Isoniazid (INH) is an essential drug for tuberculosis (TB) treatment. Resistance to INH may increase the likelihood of negative treatment outcome.
We aimed to determine the impact of INH mono-resistance on TB treatment outcome in the European Union/European Economic Area and to identify risk factors for unsuccessful outcome in cases with INH mono-resistant TB.
In this observational study, we retrospectively analysed TB cases that were diagnosed in 2002–14 and included in the European Surveillance System (TESSy). Multilevel logistic regression models were applied to identify risk factors and correct for clustering of cases within countries.
A total of 187,370 susceptible and 7,578 INH mono-resistant TB cases from 24 countries were included in the outcome analysis. Treatment was successful in 74.0% of INH mono-resistant and 77.4% of susceptible TB cases. In the final model, treatment success was lower among INH mono-resistant cases (Odds ratio (OR): 0.7; 95% confidence interval (CI): 0.6–0.9; adjusted absolute difference in treatment success: 5.3%). Among INH mono-resistant TB cases, unsuccessful treatment outcome was associated with age above median (OR: 1.3; 95% CI: 1.2–1.5), male sex (OR: 1.3; 95% CI: 1.1–1.4), positive smear microscopy (OR: 1.3; 95% CI: 1.1–1.4), positive HIV status (OR: 3.3; 95% CI: 1.6–6.5) and a prior TB history (OR: 1.8; 95% CI: 1.5–2.2).
This study provides evidence for an association between INH mono-resistance and a lower likelihood of TB treatment success. Increased attention should be paid to timely detection and management of INH mono-resistant TB.
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Keywords: Antibiotics; Drugs Resistance; Tuberculosis; European Region; Isoniazid.