Availability and costs of medicines for the treatment of tuberculosis in Europe

To evaluate the access to comprehensive diagnostics and novel antituberculosis medicines in European countries. We investigated the access to genotypic and phenotypic Mycobacterium tuberculosis drug susceptibility testing and the availability of antituberculosis drugs and calculated the cost of drugs and treatment regimens at major tuberculosis treatment centres in countries of the WHO European region where rates of drug-resistant tuberculosis are the highest among all WHO regions. Results were stratified by middle-income and high-income countries. Overall, 43 treatment centres from 43 countries participated in the study. For WHO group A drugs, the frequency of countries with the availability of phenotypic drug susceptibility testing was as follows: (a) 75% (30/40) for levofloxacin, (b) 82% (33/40) for moxifloxacin, (c) 48% (19/40) for bedaquiline, and (d) 72% (29/40) for linezolid. Overall, of the 43 countries, 36 (84%) and 24 (56%) countries had access to bedaquiline and delamanid, respectively, whereas only 6 (14%) countries had access to rifapentine. The treatment of patients with extensively drug-resistant tuberculosis with a regimen including a carbapenem was available only in 17 (40%) of the 43 countries. The median cost of regimens for drug-susceptible tuberculosis, multidrug-resistant/rifampicin-resistant tuberculosis (shorter regimen, including bedaquiline for 6 months), and extensively drug-resistant tuberculosis (including bedaquiline, delamanid, and a carbapenem) were €44 (minimum-maximum, €15-152), €764 (minimum-maximum, €542-15152), and €8709 (minimum-maximum, €7965-11759) in middle-income countries (n = 12) and €280 (minimum-maximum, €78-1084), €29765 (minimum-maximum, €11116-40584), and €217591 (minimum-maximum, €82827-320146) in high-income countries (n = 29), respectively. In countries of the WHO European region, there is a widespread lack of drug susceptibility testing capacity to new and repurposed antituberculosis drugs, lack of access to essential medications in several countries, and a high cost for the treatment of drug-resistant tuberculosis

Long-term outcomes of the global tuberculosis and COVID-19 co-infection cohort

Background: Longitudinal cohort data of patients with tuberculosis (TB) and coronavirus disease 2019 (COVID-19) are lacking. In our global study, we describe long-term outcomes of patients affected by TB and COVID-19. Methods: We collected data from 174 centres in 31 countries on all patients affected by COVID-19 and TB between 1 March 2020 and 30 September 2022. Patients were followed-up until cure, death or end of cohort time. All patients had TB and COVID-19; for analysis purposes, deaths were attributed to TB, COVID-19 or both. Survival analysis was performed using Cox proportional risk-regression models, and the log-rank test was used to compare survival and mortality attributed to TB, COVID-19 or both. Results: Overall, 788 patients with COVID-19 and TB (active or sequelae) were recruited from 31 countries, and 10.8% (n=85) died during the observation period. Survival was significantly lower among patients whose death was attributed to TB and COVID-19 versus those dying because of either TB or COVID-19 alone (p<0.001). Significant adjusted risk factors for TB mortality were higher age (hazard ratio (HR) 1.05, 95% CI 1.03-1.07), HIV infection (HR 2.29, 95% CI 1.02-5.16) and invasive ventilation (HR 4.28, 95% CI 2.34-7.83). For COVID-19 mortality, the adjusted risks were higher age (HR 1.03, 95% CI 1.02-1.04), male sex (HR 2.21, 95% CI 1.24-3.91), oxygen requirement (HR 7.93, 95% CI 3.44-18.26) and invasive ventilation (HR 2.19, 95% CI 1.36-3.53). Conclusions: In our global cohort, death was the outcome in >10% of patients with TB and COVID-19. A range of demographic and clinical predictors are associated with adverse outcomes

Prevalence and etiology of community-acquired pneumonia in immunocompromised patients

Background. The correct management of immunocompromised patients with pneumonia is debated. We evaluated the prevalence, risk factors, and characteristics of immunocompromised patients coming from the community with pneumonia. Methods. We conducted a secondary analysis of an international, multicenter study enrolling adult patients coming from the community with pneumonia and hospitalized in 222 hospitals in 54 countries worldwide. Risk factors for immunocompromise included AIDS, aplastic anemia, asplenia, hematological cancer, chemotherapy, neutropenia, biological drug use, lung transplantation, chronic steroid use, and solid tumor. Results. At least 1 risk factor for immunocompromise was recorded in 18% of the 3702 patients enrolled. The prevalences of risk factors significantly differed across continents and countries, with chronic steroid use (45%), hematological cancer (25%), and chemotherapy (22%) the most common. Among immunocompromised patients, community-acquired pneumonia (CAP) pathogens were the most frequently identified, and prevalences did not differ from those in immunocompetent patients. Risk factors for immunocompromise were independently associated with neither Pseudomonas aeruginosa nor non\u2013community-acquired bacteria. Specific risk factors were independently associated with fungal infections (odds ratio for AIDS and hematological cancer, 15.10 and 4.65, respectively; both P = .001), mycobacterial infections (AIDS; P = .006), and viral infections other than influenza (hematological cancer, 5.49; P < .001). Conclusions. Our findings could be considered by clinicians in prescribing empiric antibiotic therapy for CAP in immunocompromised patients. Patients with AIDS and hematological cancer admitted with CAP may have higher prevalences of fungi, mycobacteria, and noninfluenza viruses

Availability of drugs and resistance testing for BPaLM regimen for rifampicin-resistant tuberculosis in Europe.

OBJECTIVES Multidrug-resistant/Rifampicin-resistant tuberculosis (TB) is a major obstacle to successful TB control. The recommendation by the World Health Organization to use bedaquiline, pretomanid, linezolid and moxifloxacin (BPaL(M)) for 6 months, based on results of three trials with high efficacy and low toxicity, has revolutionized treatment options. METHODS In this study, representatives of the Tuberculosis Network European Trialsgroup (TBnet) in 44/54 countries of the WHO Europe region document the availability of the medicines and drug susceptibility testing (DST) of the BPaL(M) regimen through a structured questionnaire between September to November 2023. RESULTS 24/44 (54.5%), 42/44 (95.5%), 43/44 (97.7%), and 43/44 (97.7%) had access to pretomanid, bedaquiline, linezolid, and moxifloxacin, respectively. Overall, 23/44 (52.3%) had access to all the drugs composing the BPaL(M) regimen. 7/44 (15.9%), 28/44 (63.6%), 34/44 (77.3%) and 36/44 (81.8%) had access to DST for pretomanid, bedaquiline, linezolid and moxifloxacin, respectively. DST was available for all medicines composing the BPaL(M) regimen in 6/44 (13.6%) countries. CONCLUSION Only in about half of the countries participating in the survey clinicians have access to all the BPaL(M) regimen drugs. In less than a fifth of countries, a complete DST is possible. Rapid scale up of DST capacity to prevent unnoticed spread of drug resistance and equal access to new regimens are urgently needed in Europe

Tuberculosis and COVID-19 co-infection: description of the global cohort

177si: Information on tuberculosis (TB) and COVID-19 is still limited. The aim of this study is to describe the features of the TB/COVID-19 co-infected individuals from a prospective, anonymised, multi-country register-based cohort with special focus on the determinants of mortality and other outcomes. We enrolled all patients of any age with either active TB or previous TB and COVID-19. 172 centres from 34 countries provided individual data on 767 TB-COVID-19 co-infected patients, (>50% population-based). Of 767 patients, 553/747 (74.0%) had TB before COVID-19 (including 234/747 with previous TB), 71/747 (9.5%) had COVID-19 first and 123/747 (16.5%) had both diseases diagnosed within the same week (35, 4.6% on the same day). 85/767 patients died (11.08%) (41/289 (14.2%) in Europe and 44/478 (9.2%) outside Europe; (p=0.03)): 42 (49.4%) from COVID-19, 31 (36.5%) from COVID-19 and TB, 1/85 (1.2%) from TB and 11 from other causes. In the univariate analysis on mortality the following variables reached statistical significance: age, being male, having >1 comorbidity; diabetes mellitus, cardiovascular disease, chronic respiratory disease, chronic renal disease, presence of key symptoms, invasive ventilation and hospitalisation due to COVID-19. The final multivariable logistic regression model included age, male gender, and invasive ventilation as independent contributors to mortality. The data suggests TB and COVID-19 are a "cursed duet" and need immediate attention. TB should be considered a risk factor for severe COVID disease and patients with TB should be prioritised for COVID-19 preventative efforts, including vaccination.nonenoneTB/COVID-19 Global Study Group: Nicolas Casco, Alberto Levi Jorge, Domingo Juan Palmero, Jan-Willem Alffenaar, Justin Denholm, Greg J Fox, Wafaa Ezz, Jin-Gun Cho, Alena Skrahina, Varvara Solodovnikova, Pierre Bachez, Alberto Piubello, Marcos Abdo Arbex, Tatiana Alves, Marcelo Fouad Rabahi, Giovana Rodrigues Pereira, Roberta Sales, Denise Rossato Silva, Muntasir M Saffie, Ruth Caamaño Miranda, Viviana Cancino, Monica Carbonell, Catalina Cisterna, Clorinda Concha, Arturo Cruz, Nadia Escobar Salinas, Macarena Espinoza Revillot, Joaquín Farías Valdés, Israel Fernandez, Ximena Flores, Patricia Gallegos Tapia, Ana Garavagno, Carolina Guajardo Vera, Martina Hartwig Bahamondes, Luis Moyano Merino, Eduardo Muñoz, Camila Muñoz, Indira Navarro, Jorge Navarro Subiabre, Carlos Ortega, Sofia Palma, Ana María Pradenas, Gloria Pereira, Patricia Perez Castillo, Mónica Pinto, Rolando Pizarro, Francisco Rivas Bidegain, Patricia Rodriguez, Cristina Sánchez, Angeles Serrano Salinas, Aline Soto, Carolina Taiba, Margarita Venegas, Maria Soledad Vergara Riquelme, Evelyn Vilca, Claudia Villalón, Edith Yucra, Yang Li, Andres Cruz, Beatriz Guelvez, Regina Victoria Plaza, Kelly Yoana Tello Hoyos, Claire Andréjak, François-Xavier Blanc, Samir Dourmane, Antoine Froissart, Armine Izadifar, Frédéric Rivière, Frédéric Schlemmer, Katerina Manika, Nitesh Gupta, Pranav Ish, Gyanshankar Mishra, Samridhi Sharma, Rupak Singla, Zarir F Udwadia, Boubacar Djelo Diallo, Souleymane Hassane-Harouna, Norma Artiles, Licenciada Andrea Mejia, Francesca Alladio, Fabio Angeli, Andrea Calcagno, Rosella Centis, Luigi Ruffo Codecasa, Lia D'Ambrosio, Angelo De Lauretis, Susanna Esposito, Beatrice Formenti, Alberto Gaviraghi, Vania Giacomet, Delia Goletti, Gina Gualano, Alberto Matteelli, Giovanni Battista Migliori, Ilaria Motta, Fabrizio Palmieri, Emanuele Pontali, Tullio Prestileo, Niccolò Riccardi, Laura Saderi, Matteo Saporiti, Giovanni Sotgiu, Claudia Stochino, Marina Tadolini, Alessandro Torre, Simone Villa, Dina Visca, Edvardas Danila, Saulius Diktanas, Ruy López Ridaura, Fátima Leticia Luna López, Marcela Muñoz Torrico, Adrian Rendon, Onno W Akkerman, Mahamadou Bassirou Souleymane, Seif Al-Abri, Fatma Alyaquobi, Khalsa Althohli, Edwin Aizpurua, Rolando Gonzales, Julio Jurado, Alejandra Loban, Sarita Aguirre, Rosarito Coronel Teixeira, Viviana De Egea, Sandra Irala, Angélica Medina, Guillermo Sequera, Natalia Sosa, Fátima Vázquez, Félix K Llanos-Tejada, Selene Manga, Renzo Villanueva -Villegas, David Araujo, Raquel Duarte, Tânia Sales Marques, Victor Ionel Grecu, Adriana Socaci, Olga Barkanova, Maria Bogorodskaya, Sergey Borisov, Andrei Mariandyshev, Anna Kaluzhenina, Tatjana Adzic Vukicevic, Maja Stosic, Darius Beh, Deborah Ng, Catherine W M Ong, Ivan Solovic, Keertan Dheda, Phindile Gina, José A Caminero, José Cardoso-Landivar, Maria Luiza De Souza Galvão, Angel Dominguez-Castellano, José-María García-García, Israel Molina Pinargote, Sarai Quirós Fernandez, Adrián Sánchez-Montalvá, Eva Tabernero Huguet, Miguel Zabaleta Murguiondo, Pierre-Alexandre Bart, Jesica Mazza-Stalder, Freya Bakko, James Barnacle, Annabel Brown, Shruthi Chandran, Kieran Killington, Kathy Man, Padmasayee Papineni, Simon Tiberi, Natasa Utjesanovic, Dominik Zenner, Jasie L Hearn, Scott Heysell, Laura YoungGlobal Study Group: Nicolas Casco, TB/COVID-19; Levi Jorge, Alberto; Juan Palmero, Domingo; Alffenaar, Jan-Willem; Denholm, Justin; J Fox, Greg; Ezz, Wafaa; Cho, Jin-Gun; Skrahina, Alena; Solodovnikova, Varvara; Bachez, Pierre; Piubello, Alberto; Abdo Arbex, Marcos; Alves, Tatiana; Fouad Rabahi, Marcelo; Rodrigues Pereira, Giovana; Sales, Roberta; Rossato Silva, Denise; M Saffie, Muntasir; Caamaño Miranda, Ruth; Cancino, Viviana; Carbonell, Monica; Cisterna, Catalina; Concha, Clorinda; Cruz, Arturo; Escobar Salinas, Nadia; Espinoza Revillot, Macarena; Farías Valdés, Joaquín; Fernandez, Israel; Flores, Ximena; Gallegos Tapia, Patricia; Garavagno, Ana; Guajardo Vera, Carolina; Hartwig Bahamondes, Martina; Moyano Merino, Luis; Muñoz, Eduardo; Muñoz, Camila; Navarro, Indira; Navarro Subiabre, Jorge; Ortega, Carlos; Palma, Sofia; María Pradenas, Ana; Pereira, Gloria; Perez Castillo, Patricia; Pinto, Mónica; Pizarro, Rolando; Rivas Bidegain, Francisco; Rodriguez, Patricia; Sánchez, Cristina; Serrano Salinas, Angeles; Soto, Aline; Taiba, Carolina; Venegas, Margarita; Soledad Vergara Riquelme, Maria; Vilca, Evelyn; Villalón, Claudia; Yucra, Edith; Li, Yang; Cruz, Andres; Guelvez, Beatriz; Victoria Plaza, Regina; Yoana Tello Hoyos, Kelly; Andréjak, Claire; Blanc, François-Xavier; Dourmane, Samir; Froissart, Antoine; Izadifar, Armine; Rivière, Frédéric; Schlemmer, Frédéric; Manika, Katerina; Gupta, Nitesh; Ish, Pranav; Mishra, Gyanshankar; Sharma, Samridhi; Singla, Rupak; F Udwadia, Zarir; Djelo Diallo, Boubacar; Hassane-Harouna, Souleymane; Artiles, Norma; Andrea Mejia, Licenciada; Alladio, Francesca; Angeli, Fabio; Calcagno, Andrea; Centis, Rosella; Ruffo Codecasa, Luigi; D'Ambrosio, Lia; De Lauretis, Angelo; Esposito, Susanna; Formenti, Beatrice; Gaviraghi, Alberto; Giacomet, Vania; Goletti, Delia; Gualano, Gina; Matteelli, Alberto; Battista Migliori, Giovanni; Motta, Ilaria; Palmieri, Fabrizio; Pontali, Emanuele; Prestileo, Tullio; Riccardi, Niccolò; Saderi, Laura; Saporiti, Matteo; Sotgiu, Giovanni; Stochino, Claudia; Tadolini, Marina; Torre, Alessandro; Villa, Simone; Visca, Dina; Danila, Edvardas; Diktanas, Saulius; López Ridaura, Ruy; Leticia Luna López, Fátima; Muñoz Torrico, Marcela; Rendon, Adrian; W Akkerman, Onno; Bassirou Souleymane, Mahamadou; Al-Abri, Seif; Alyaquobi, Fatma; Althohli, Khalsa; Aizpurua, Edwin; Gonzales, Rolando; Jurado, Julio; Loban, Alejandra; Aguirre, Sarita; Coronel Teixeira, Rosarito; De Egea, Viviana; Irala, Sandra; Medina, Angélica; Sequera, Guillermo; Sosa, Natalia; Vázquez, Fátima; K Llanos-Tejada, Félix; Manga, Selene; Villanueva -Villegas, Renzo; Araujo, David; Duarte, Raquel; Sales Marques, Tânia; Ionel Grecu, Victor; Socaci, Adriana; Barkanova, Olga; Bogorodskaya, Maria; Borisov, Sergey; Mariandyshev, Andrei; Kaluzhenina, Anna; Adzic Vukicevic, Tatjana; Stosic, Maja; Beh, Darius; Ng, Deborah; M Ong, Catherine W; Solovic, Ivan; Dheda, Keertan; Gina, Phindile; A Caminero, José; Cardoso-Landivar, José; Luiza De Souza Galvão, Maria; Dominguez-Castellano, Angel; García-García, José-María; Molina Pinargote, Israel; Quirós Fernandez, Sarai; Sánchez-Montalvá, Adrián; Tabernero Huguet, Eva; Zabaleta Murguiondo, Miguel; Bart, Pierre-Alexandre; Mazza-Stalder, Jesica; Bakko, Freya; Barnacle, James; Brown, Annabel; Chandran, Shruthi; Killington, Kieran; Man, Kathy; Papineni, Padmasayee; Tiberi, Simon; Utjesanovic, Natasa; Zenner, Dominik; L Hearn, Jasie; Heysell, Scott; Young, Laur

Correction to: Atypical pathogens in hospitalized patients with community-acquired pneumonia: a worldwide perspective

An amendment to this paper has been published and can be accessed via the original article.</jats:p