Effectiveness and safety of meropenem/clavulanate-containing regimens in the treatment of MDR- and XDR-TB

被引：88

作者：

Tiberi, Simon ^{[1
]}

Payen, Marie-Christine ^{[2
]}

Sotgiu, Giovanni ^{[3
]}

D'Ambrosio, Lia ^{[4
,5
]}

Guizado, Valentina Alarcon ^{[6
]}

Alffenaar, Jan Willem ^{[7
]}

Arbex, Marcos Abdo ^{[8
,9
]}

Caminero, Jose A. ^{[10
,11
]}

Centis, Rosella ^{[4
]}

De Lorenzo, Saverio ^{[12
]}

Gaga, Mina ^{[13
]}

Gualano, Gina ^{[14
]}

Roby Arias, Aurora Jazmin ^{[15
]}

Scardigli, Anna

Skrahina, Alena ^{[16
]}

Solovic, Ivan ^{[17
]}

Sulis, Giorgia ^{[18
,19
]}

Tadolini, Marina ^{[20
]}

Akkerman, Onno W. ^{[21
]}

Arrascue, Edith Alarcon ^{[11
]}

Aleska, Alena ^{[23
]}

Avchinko, Vera

Bonini, Eduardo Henrique ^{[8
,9
,22
]}

Chong Marin, Felix Antonio ^{[15
]}

Lopez, Lorena Collahuazo ^{[15
]}

de Vries, Gerard ^{[24
]}

Dore, Simone

Kunst, Heinke ^{[25
]}

Matteelli, Alberto ^{[18
,19
]}

Moschos, Charalampos ^{[13
]}

Palmieri, Fabrizio ^{[14
]}

Papavasileiou, Apostolos ^{[13
]}

Spanevello, Antonio ^{[26
,27
]}

Vasquez, Dante Vargas ^{[28
]}

Viggiani, Pietro ^{[12
]}

White, Veronica ^{[29
]}

Zumla, Alimuddin ^{[30
,31
]}

Migliori, Giovanni Battista ^{[4
]}

机构：

[1] Barts Healthcare NHS Trust, Div Infect, London, England

[2] ULB, CHU St Pierre, Div Infect Dis, Brussels, Belgium

[3] Univ Sassari, Res Med Educ & Profess Dev Unit, Dept Biomed Sci, Clin Epidemiol & Med Stat Unit,AOU Sassari, Sassari, Italy

[4] WHO, Collaborating Ctr TB & Lung Dis, Fdn S Maugeri, Tradate, Italy

[5] Publ Hlth Consulting Grp, Lugano, Switzerland

[6] Minist Hlth, Natl TB Control Programme, Lima, Peru

[7] Univ Groningen, Univ Med Ctr Groningen, Dept Clin Pharm & Pharmacol, Groningen, Netherlands

[8] Univ Ctr Araraquara, Sao Paulo, Brazil

[9] Hosp Nestor Goulart Reis, Sao Paulo State Secretary Hlth, Sao Paulo, Brazil

[10] Hosp Gen Gran Canaria Dr Negrin, Dept Pneumol, Las Palmas Gran Canaria, Spain

[11] Int Union TB & Lung Dis Union, TB Div, MDR TB Unit, Paris, France

[12] AOVV E Morelli Hosp, Reference Hosp MDR & HIV TB, Sondalo, Italy

[13] Athens Chest Hosp Sotiria, Natl Referral Ctr Mycobacteria, MDR TB Unit, Athens, Greece

[14] Natl Inst Infect Dis L Spallanzani, Resp Infect Dis Unit, Rome, Italy

[15] Pulmonol Hosp Alfredo J Valenzuela, Natl TB Control Programme, Guayaquil, Ecuador

[16] Republican Res & Pract Ctr Pulmonol & TB, Minsk, BELARUS

[17] Natl Inst TB Lung Dis & Thorac Surg, Vysne Hagy, Slovakia

[18] Univ Brescia, WHO, Collaborating Ctr TB HIV Coinfect & TB Eliminat, Univ Dept Infect & Trop Dis, Brescia, Italy

[19] Brescia Spedali Civili Gen Hosp, Brescia, Italy

[20] Alma Mater Studiorum Univ Bologna, Dept Med & Surg Sci, Unit Infect Dis, Bologna, Italy

[21] Univ Groningen, Univ Med Ctr Groningen, TB Ctr Beatrixoord, Dept Pulm Dis & TB, Groningen, Netherlands

[22] Int Union TB & Lung Dis Union, Lima, Peru

[23] Grodno State Med Univ, Educ Inst, Grodno, BELARUS

[24] KNCV TB Fdn, The Hague, Netherlands

[25] Queen Mary Univ, Dept Resp Med, London, England

[26] IRCCS, Fdn Maugeri, Pneumol Unit, Tradate, Italy

[27] Univ Insubria, Dept Clin & Expt Med, Varese, Italy

[28] Minist Hlth, Inst Publ Hlth, Natl Hosp Hipolito Unanue, Lima, Peru

[29] Barts Healthcare NHS Trust, Dept Resp Med, London, England

[30] UCL, Div Infect & Immun, London, England

[31] UCL Hosp NHS Fdn Trust London, NIHR Biomed Res Ctr, London, ON, Canada

来源：

EUROPEAN RESPIRATORY JOURNAL | 2016年 / 47卷 / 04期

关键词：

DRUG-RESISTANT TUBERCULOSIS; MULTIDRUG-RESISTANT; MEROPENEM-CLAVULANATE; LINEZOLID SAFETY; EFFICACY; BEDAQUILINE; COMPASSIONATE; TOLERABILITY; DELAMANID; ELIMINATION;

D O I：

10.1183/13993003.02146-2015

中图分类号：

R56 [呼吸系及胸部疾病];

学科分类号：

100201 [内科学];

摘要：

No large study has ever evaluated the efficacy, safety and tolerability of meropenem/clavulanate to treat multidrug-and extensively drug-resistant tuberculosis (MDR-and XDR-TB). The aim of this observational study was to evaluate the therapeutic contribution, effectiveness, safety and tolerability profile of meropenem/clavulanate added to a background regimen when treating MDR-and XDR-TB cases. Patients treated with a meropenem/clavulanate-containing regimen (n=96) showed a greater drug resistance profile than those exposed to a meropenem/clavulanate-sparing regimen (n=168): in the former group XDR-TB was more frequent (49% versus 6.0%, p<0.0001) and the median (interquartile range (IQR)) number of antibiotic resistances was higher (8 (6-9) versus 5 (4-6)). Patients were treated with a meropenem/clavulanate-containing regimen for a median (IQR) of 85 (49-156) days. No statistically significant differences were observed in the overall MDR-TB cohort and in the subgroups with and without the XDR-TB patients; in particular, sputum smear and culture conversion rates were similar in XDR-TB patients exposed to meropenem/clavulanate-containing regimens (88.0% versus 100.0%, p=1.00 and 88.0% versus 100.0%, p=1.00, respectively). Only six cases reported adverse events attributable to meropenem/clavulanate (four of them then restarting treatment). The nondifferent outcomes and bacteriological conversion rate observed in cases who were more severe than controls might imply that meropenem/clavulanate could be active in treating MDR-and XDR-TB cases.

引用

页码：1235 / 1243

页数：9

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