Evidence map›Paper›PMID 30744962›Full record

ArticleThe Lancet. Infectious diseases2019

Drug susceptibility testing and mortality in patients treated for tuberculosis in high-burden countries: a multicentre cohort study.

Kathrin Zürcher, Marie Ballif, Lukas Fenner, Sonia Borrell, Peter M Keller, Joachim Gnokoro, Olivier Marcy, Marcel Yotebieng, Lameck Diero, E Jane Carter and 15 more

Open access · greenAbstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in The Lancet. Infectious diseases, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
30citing papers in PubMed, 4 pooled it
6.4field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

30 citing papers in PubMed, 4 syntheses or guidelines pooled it, 63 citations in OpenAlex.

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  12. Discordance between genotypic and phenotypic methods for the detection of rifampicin and isoniazid resistantJournal of clinical tuberculosis and other mycobacterial diseases · 2024
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

25 authors at 19 institutions in 10 countries.

Kathrin ZürcherInstitute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland; Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
Marie BallifInstitute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
Lukas FennerInstitute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
Sonia BorrellSwiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
Peter M KellerInstitute of Medical Microbiology, University of Zurich, Zurich, Switzerland; Swiss National Center for Mycobacteria, Zurich, Switzerland.
Joachim GnokoroCentre de Prise en Charge de Recherche et de Formation, Yopougon, Abidjan, Côte d'Ivoire.
Olivier MarcyBordeaux Population Health Research Center, Inserm U1219, University of Bordeaux, Bordeaux, France.
Marcel YotebiengOhio State University, College of Public Health, Columbus, OH, USA.
Lameck DieroDepartment of Medicine, Moi University School of Medicine, and Moi Teaching and Referral Hospital, Eldoret, Kenya.
E Jane CarterDepartment of Medicine, Moi University School of Medicine, and Moi Teaching and Referral Hospital, Eldoret, Kenya.
Neesha RockwoodWellcome Centre for Infectious Diseases Research in Africa, University of Cape Town, Cape Town, South Africa; Department of Medicine, Imperial College London, London, UK.
Robert J WilkinsonWellcome Centre for Infectious Diseases Research in Africa, University of Cape Town, Cape Town, South Africa; Department of Medicine, Imperial College London, London, UK; Francis Crick Institute, London, UK.
Helen CoxDivision of Medical Microbiology and the Institute for Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
Nicholas EzatiInstitute of Human Virology, Abuja, Nigeria; National Tuberculosis and Leprosy Training Center, Saye, Zaria, Kaduna State, Nigeria.
Alash'le G AbimikuInstitute of Human Virology, Abuja, Nigeria.
Jimena CollantesInstituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru.
Anchalee AvihingsanonHIV-NAT/Thai Red Cross AIDS Research Centre, Bangkok, Thailand.
Kamon KawkitinarongHIV-NAT/Thai Red Cross AIDS Research Centre, Bangkok, Thailand; Tuberculosis Research Unit, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Miriam ReinhardSwiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
Rico HömkeInstitute of Medical Microbiology, University of Zurich, Zurich, Switzerland; Swiss National Center for Mycobacteria, Zurich, Switzerland.
Robin HuebnerNational Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA.
Sebastien GagneuxSwiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
Erik C BöttgerInstitute of Medical Microbiology, University of Zurich, Zurich, Switzerland; Swiss National Center for Mycobacteria, Zurich, Switzerland.
Matthias EggerInstitute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland; Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa. Electronic address: matthias.egger@ispm.unibe.ch.
International epidemiology Databases to Evaluate AIDS (IeDEA) consortium
University of Bern · CHMoi University · KESwiss Tropical and Public Health Institute · CHUniversity of Cape Town · ZAUniversity of Zurich · CHHIV Netherlands Australia Thailand Research Collaboration · THInstitute of Human Virology · NGNational Institute of Allergy and Infectious Diseases · USUniversity of Basel · CHCentre Hospitalier Universitaire de Yopougon · CIInstitute of Social and Preventive Medicine · CHSwiss National Bank · CHThe Ohio State University · USUniversidad Peruana Cayetano Heredia · PEWellcome Centre for Infectious Diseases Research in Africa · ZABordeaux Population Health · FRChulalongkorn University · THFederal Neuro Psychiatric Hospital · NGUniversité de Bordeaux · FR

Funding

East Africa International Epidemiology Database to evaluate AIDS (IeDEA) Regional ConsortiumU01AI069911 · NIAID · INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS · PI AGGREY SEMWENDERO SEMEERE, Kara Kay Wools-Kaloustian · 2006 to 2026
$57.7M
Observational Antiretroviral Studies In Southern Africa (OASIS) CollaborationU01AI069924 · NIAID · UNIVERSITAT BERN · PI Cleophas Chimbetete, Mary-Ann Davies · 2006 to 2026
$55.9M
The Asia-Pacific HIV Research CollaborationU01AI069907 · NIAID · FOUNDATION FOR AIDS RESEARCH · PI ANNETTE H SOHN · 2006 to 2026
$44.8M
CCASAnet: Caribbean, Central and South America NetworkU01AI069923 · NIAID · VANDERBILT UNIVERSITY MEDICAL CENTER · PI Pedro Enrique Cahn, Jessica L Castilho · 2006 to 2026
$41.6M
"Enhancing Cancer Research in Central Africa IeDEA"U01AI096299 · NIAID · ALBERT EINSTEIN COLLEGE OF MEDICINE, INC · PI Denis Nash, Marcel Yotebieng · 2011 to 2026
$35.8M
WADA (West Africa Database on Antiretroviral Therapy) CollaborationU01AI069919 · NIAID · UNIVERSITY OF BORDEAUX II · PI Didier Koumavi Ekouevi, Antoine Jaquet · 2006 to 2026
$29.9M
leDEA Networks Coordinating Center at VanderbiltU01AI096186 · NIAID · VANDERBILT UNIVERSITY MEDICAL CENTER · PI LINDEGREN, MARY LOU, WESTER, C. WILLIAM · 2011 to 2015
$2.3M
NIAID NIH HHS U01 AI069907NIAID NIH HHS U01 AI069911NIAID NIH HHS U01 AI069919NIAID NIH HHS U01 AI069923NIAID NIH HHS U01 AI069924NIAID NIH HHS U01 AI096186NIAID NIH HHS U01 AI096299Wellcome Trust
6 · The paper itself

Abstract

backgroundDrug resistance is a challenge for the global control of tuberculosis. We examined mortality in patients with tuberculosis from high-burden countries, according to concordance or discordance of results from drug susceptibility testing done locally and in a reference laboratory.

methodsThis multicentre cohort study was done in Côte d'Ivoire, Democratic Republic of the Congo, Kenya, Nigeria, South Africa, Peru, and Thailand. We collected Mycobacterium tuberculosis isolates and clinical data from adult patients aged 16 years or older. Patients were stratified by HIV status and tuberculosis drug resistance. Molecular or phenotypic drug susceptibility testing was done locally and at the Swiss National Center for Mycobacteria, Zurich, Switzerland. We examined mortality during treatment according to drug susceptibility test results and treatment adequacy in multivariable logistic regression models adjusting for sex, age, sputum microscopy, and HIV status.

findingsWe obtained M tuberculosis isolates from 871 patients diagnosed between 2013 and 2016. After exclusion of 237 patients, 634 patients with tuberculosis were included in this analysis; the median age was 33·2 years (IQR 26·9-42·5), 239 (38%) were women, 272 (43%) were HIV-positive, and 69 (11%) patients died. Based on the reference laboratory drug susceptibility test, 394 (62%) strains were pan-susceptible, 45 (7%) monoresistant, 163 (26%) multidrug-resistant (MDR), and 30 (5%) had pre-extensively or extensively drug resistant (pre-XDR or XDR) tuberculosis. Results of reference and local laboratories were concordant for 513 (81%) of 634 patients and discordant for 121 (19%) of 634. Overall, sensitivity to detect any resistance was 90·8% (95% CI 86·5-94·2) and specificity 84·3% (80·3-87·7). Mortality ranged from 6% (20 of 336) in patients with pan-susceptible tuberculosis treated according to WHO guidelines to 57% (eight of 14) in patients with resistant strains who were under-treated. In logistic regression models, compared with concordant drug susceptibility test results, the adjusted odds ratio of death was 7·33 (95% CI 2·70-19·95) for patients with discordant results potentially leading to under-treatment.

interpretationInaccurate drug susceptibility testing by comparison with a reference standard leads to under-treatment of drug-resistant tuberculosis and increased mortality. Rapid molecular drug susceptibility test of first-line and second-line drugs at diagnosis is required to improve outcomes in patients with MDR tuberculosis and pre-XDR or XDR tuberculosis.

fundingNational Institutes of Allergy and Infectious Diseases, Swiss National Science Foundation, Swiss National Center for Mycobacteria.

Indexed as

Diagnostic ErrorsDrug Resistance, BacterialAdolescentAdultAfricaAgedAged, 80 and overCohort StudiesFemaleHumansMaleMicrobial Sensitivity TestsMiddle AgedMycobacterium tuberculosisPeruSensitivity and Specificity

Identifiers

PMID30744962
PMCPMC6482382
OpenAlexW2915052082

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.