Latent tuberculosis infection among contacts of patients with multidrug-resistant tuberculosis in New South Wales, Australia.

BACKGROUND: Contacts of an individual with active tuberculosis (TB) disease have a higher risk of developing latent TB infection (LTBI) or active TB disease. Contact tracing is a public health measure that seeks to identify exposed contacts, screen them for co-prevalent TB and consider prophylactic treatment to prevent progression from LTBI to active TB disease. The investigators sought to determine the prevalence of LTBI and active TB disease among contacts of patients with multidrug-resistant (MDR)-TB in New South Wales, Australia. METHODOLOGY: A retrospective cohort study was performed among the contacts of patients diagnosed with MDR-TB between 2000 and 2016, inclusive, at seven chest clinics. Medical records were used to identify eligible contacts. Outcomes of screening and prophylactic treatment regimens offered to MDR-TB contacts with LTBI were characterised. Collected data included demographic information, screening tests results and initial management. RESULTS: In total, 247 contacts of 55 MDR-TB patients were identified. LTBI was identified in 105 contacts (42.5%). Preventive treatment was received by 20 contacts with LTBI (32.3%) in the form of various regimens, ranging from one to three antimicrobials, with various doses and durations. One contact with LTBI who was untreated progressed to active TB disease during the study period, according to clinic notes. CONCLUSION: Contacts of MDR-TB patients have a high prevalence of LTBI. Management of these contacts varies substantially in New South Wales, reflecting a lack of definitive evidence for preventive therapy. Further research is required to determine the optimal management of this population.

Individualised treatment for multidrug-resistant tuberculosis in New South Wales, Australia.

OBJECTIVE: Multidrug-resistant tuberculosis (MDR-TB) presents a major global health challenge. In high-income countries, treatment is individualised to optimise efficacy and reduce toxicity. We aimed to evaluate the outcomes of patients with MDR-TB receiving individualised antibiotic therapy in Australia. METHODS: This retrospective cohort study was performed in the city of Sydney in Australia and included patients diagnosed with bacteriologically confirmed MDR-TB diagnosed between 2000 and 2016. The clinical characteristics of patients and treatment details were extracted from medical records. The incidence of adverse events and end-of-treatment outcomes were also evaluated. RESULTS: Fifty-five patients with MDR-TB were identified at TB clinics in seven hospitals. The median age was 32 years (interquartile range [IQR]: 27-36 years). The median duration of the intensive phase treatment was six months (IQR 6-7 months). All patients' treatment administration was directly observed. The commonest reported adverse event was ototoxicity (44%; 23/52) and successful treatment outcomes were achieved by 95% (52/55) of patients. CONCLUSION: This study demonstrated the high treatment success rate that can be achieved using individualised treatment for MDR-TB in a well-resourced setting. Implications for public health: The expansion of individualised therapy promises to contribute to MDR-TB control and advance the ambitious goal of TB elimination by 2035.