Pyrosequencing Detects Tuberculosis Drug Resistance and Improves Management - Infectious Disease Advisor

-
December 28, 2018
Share this content:
Pyrosequencing may benefit clinical decision making and reduce time to start of effective treatment in patients with drug-resistant tuberculosis.
Pyrosequencing may benefit clinical decision making and reduce time to start of effective treatment in patients with drug-resistant tuberculosis.

Pyrosequencing may benefit clinical decision making and reduce time to start of effective treatment in patients with drug-resistant tuberculosis (TB), according to study results published in Clinical Infectious Diseases.

The emergence and spread of multidrug-resistant TB (MDR-TB) is a barrier to TB elimination and a threat to TB control. MDR-TB is resistant to the most effective first-line medications, including isoniazid and rifampin, and was reported in approximately 1.8% of patients with TB in California in 2017. Rapid diagnosis of drug-resistant TB is critical to the initiation of an effective treatment regimen. Culture-based phenotypic methods usually require >4 weeks, which results in delayed diagnosis, treatment with ineffective drugs, poor treatment outcomes, and spread of drug-resistant TB. In addition, culture-based phenotypic methods may miss mutations that confer low-level rifampin resistance. Rapid molecular drug susceptibility testing for TB is an important tool for detecting mutations associated with resistance.

Continue Reading Below

In 2012, the California Department of Public Health began offering a molecular drug susceptibility assay using pyrosequencing for the detection of mutations associated with resistance to isoniazid, rifampin, quinolones, and injectable drugs in the Mycobacterium tuberculosis complex. As pyrosequencing provides sequence results, it goes a step further than previous molecular tests by providing the precise sequence of mutation since not all mutations confer drug resistance and mutations can confer different levels of resistance. Therefore, this study evaluated the effect of the pyrosequencing assay on the initiation of MDR treatment and how pyrosequencing might influence clinicians' decisions regarding the management of TB patients in California.

TB surveillance and laboratory data for specimens submitted between 2012 and 2016 were analyzed to determine time to effective treatment initiation. A survey of clinicians was used to analyze how pyrosequencing results were influencing clinical decision making.

The results demonstrated that in patients with MDR-TB effective treatment was initiated 5 weeks earlier when pyrosequencing was used and that the use of pyrosequencing influenced clinical decisions in a substantial number of cases. The pyrosequencing turnaround time for results was a median of 1 day, but the time from specimen collection to receipt date was >1 week. Therefore, optimization of the gap between specimen collection and submission for pyrosequencing would provide significant improvement for the test. In patients who had no changes in their treatment regimen, nearly one-fifth of providers indicated that pyrosequencing was a reason for choosing the regimen, meaning that pyrosequencing was used to confirm susceptibility of drugs. In more than one-third of patients with changes to their drug regimen, pyrosequencing was indicated as a reason for the change. Further, survey results confirmed that pyrosequencing results triggered additional testing and consultation in many patients, particularly patients with a resistance mutation.

Related Articles

Overall, the findings show that pyrosequencing lessens the time to effective treatment initiation in patients with MDR-TB and helped tailor patients' drug regimens to optimize their effectiveness. The study authors concluded that, “Nevertheless, further improvement can be made to reduce the time to initiate MDR-TB treatment by recognizing MDR-TB risks and submitting smear negative sputa rapidly for [pyrosequencing].”

Reference

Lowenthal P, Lin SYG, Desmond E, Shah N, Flood J, Barry PM. Evaluation of the impact of a sequencing assay for detection of drug resistance on the clinical management of tuberculosis [published online November 1, 2018]. Clin Infect Dis. doi:10.1093/cid/ciy937/5154873



http://bit.ly/2QaHfIi

Comments

Post a Comment

Popular posts from this blog

Rash behind ear: Causes, other symptoms, and treatment - Medical News Today

-
Image
A rash behind the ear may occur due to a variety of different medical conditions. Certain viral infections and autoimmune diseases may cause a rash behind the ear in both children and adults. While some causes, such as contact dermatitis, are not concerning, other causes, including rubella, may be more serious. In this article, we look at some of the causes of a rash behind the ear, as well as the other symptoms that they may produce and how to treat them. Contact dermatitis is an allergic reaction to a particular substance. If an allergy-inducing substance comes into contact with the skin behind the ear, a rash can form. Allergens that may cause contact dermatitis behind the ears include: shampoos soaps other hair care products For example, hair dye products contain an ingredient called paraphenylenediamine (PPD), which is a common contact allergen. Symptoms Contact dermatitis causes itchiness, dryness, and flaking of the skin that came into contact with the allergen. Diagnosis A doc
Read more

Robert Zakar gives back to community

-
Image
tb in pregnancy :: Article Creator TB Fight Goes To Vulnerable Communities Tuberculosis (TB) is still the most deadly infectious disease in the world, killing over 4 000 people every day, according to the World Health Organisation (WHO). As such, in compliance with the latest WHO Latent TB Infection (LTBI) guidelines, in 2020, the Ministry of Health rolled out short-course rifapentine-based TB Preventive Therapies (TPT) nationally as one way of providing equitable access to TB preventive therapy to all those eligible. Latent TB infection means that not everyone who is infected with TB immediately develops the TB disease. Some people go on to have a dormant form of TB that can be reactivated over time or when the immune system is suppressed. So treating LTBI will prevent the person from getting active TB. However, most people in rural areas are still not aware of how they can access the treatment. To complement government's efforts in respo
Read more

Download Communicable Disease School Nurse Guidance

-
Image
toenail bacterial infection :: Article Creator How Do I Get Rid Of Toenail Fungus? Q: It looks like I have fungus beneath my toenail, but how can I be sure? Does toenail fungus go away on its own? Yellowing, brittle and unusual-looking toenails can be a sign that a fungal nail infection, called onychomycosis, has taken root. Experts say these infections don't go away on their own and can easily spread from person to person without treatment. "Fungus tends to be greedy," said Dr. Boni Elewski, chair of the department of dermatology at the University of Alabama at Birmingham. If you pick it up from close contact with someone who is infected or by walking barefoot in a locker room, for instance, it can then crawl under your toenail and spread into the nail itself, she said. Wearing moist, sweaty shoes can encourage the fungus to grow. Toenail fungus affects an estimated one in 10 people worldwide, and becomes more common with age — afflicti
Read more