4 research outputs found
Predictors of delayed culture conversion among Ugandan patients.
BACKGROUND: Estimates of month-2 culture conversion, a proxy indicator of tuberculosis (TB) treatment efficacy in phase-2 trials can vary by culture-type and geographically with lower rates reported among African sites. The sub-study aimed at comparing TB detection rates of different culture media, within and across rifampicin-based regimens (R10, 15 and 20 mg/Kg) over a 6-month treatment follow-up period, and to establish predictors of month-2 culture non-conversion among HIV-negative TB patients enrolled at RIFATOX trial site in Uganda. METHODS: Unlike in other Rifatox Trial sites, it is only in Uganda were Lowenstein-Jensen (LJ) and Mycobacteria growth indicator tube (MGIT) were used throughout 6-months for treatment monitoring. Conversion rates were compared at month-2, 4 and 6 across cultures and treatment-type. Binomial regression analysis performed for predictors of month-2 non-conversion. RESULTS: Of the 100 enrolled patients, 45% had converted based on combined LJ and MGIT by month-2, with no significant differences across treatment arms, p = 0.721. LJ exhibited higher conversion rates than MGIT at month-2 (58.4% vs 56.0%, p = 0.0707) and month-4 (98.9% vs 88.4%, p = 0.0391) respectively, more so within the high-dose rifampicin arms. All patients had converted by month-6. Time-to-TB detection (TTD) on MGIT and social service jobs independently predict month-2 non-conversion. CONCLUSION: The month-2 culture conversion used in phase 2 clinical trials as surrogate marker of treatment efficacy is influenced by the culture method used for monitoring mycobacterial response to TB treatment. Therefore, multi-centric TB therapeutic trials using early efficacy endpoint should use the same culture method across sites. The Time-to-detection of MTB on MGIT prior to treatment and working in Social service jobs bear an increased risk of culture non-conversion at month-2. TRIAL REGISTRATION: ISRCTN ISRCTN55670677 . Registered 09th November 2010. Retrospectively registered
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The potential impact of the COVID-19 pandemic on global antimicrobial and biocide resistance : an AMR Insights global perspective
The COVID-19 pandemic presents a serious public health challenge in all countries. However, repercussions of
severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections on future global health
are still being investigated, including the pandemic’s potential effect on the emergence and spread of global
antimicrobial resistance (AMR). Critically ill COVID-19 patients may develop severe complications, which may
predispose patients to infection with nosocomial bacterial and/or fungal pathogens, requiring the extensive
use of antibiotics. However, antibiotics may also be inappropriately used in milder cases of COVID-19
infection. Further, concerns such as increased biocide use, antimicrobial stewardship/infection control, AMR
awareness, the need for diagnostics (including rapid and point-of-care diagnostics) and the usefulness of
vaccination could all be components shaping the influence of the COVID-19 pandemic. In this publication, the
authors present a brief overview of the COVID-19 pandemic and associated issues that could influence
the pandemic’s effect on global AMR.This study was supported by internal funding.https://academic.oup.com/jacamram2022School of Health Systems and Public Health (SHSPH