TB and MDR/XDR-TB in the EU and EEA countries: managed or mismanaged? -
TB and MDR/XDR-TB in the EU and EEA countries: managed or mismanaged?
Eur Respir J. 2012 Feb 9;
Authors: Migliori GB, Sotgiu G, D'Ambrosio L, Centis R, Lange C, Bothamley G, Cirillo DM, De Lorenzo S, Guenther G, Kliiman K, Muetterlein R, Spinu V, Villar M, Zellweger JP, Sandgren A, Huitric E, Manissero D
Abstract
In spite of the growing awareness of emerging drug-resistant M. tuberculosis, the extent of inappropriate tuberculosis (TB) case-management may be underestimated, even in Europe.We evaluated TB case-management in the EU/EEA countries, with special focus on multi- and extensively drug-resistant (MDR/XDR) TB, using a purposely developed, standardised survey tool.National reference centres in five countries representing different geographical, socio-economical and epidemiological patterns of TB in Europe were surveyed. Forty consecutive, original clinical TB case-records (30 MDR-/XDR-TB) in each of the 5 countries were reviewed. The findings were recorded and, through the survey tool, compared with previously agreed and identified international standards.Deviations from international standards of TB care were observed in the areas of surveillance (no information available on patient outcomes), infection control (lack of respiratory isolation rooms/procedures, and negative-pressure ventilation rooms), clinical management of TB, MDR-TB and HIV co-infection (inadequate bacteriological diagnosis, regimen selection and treatment duration), laboratory support and diagnostic/treatment algorithms.Gaps between present international standards of care and the management of MDR/XDR-TB patients were identified. Training, increased awareness, promotion of standards, and allocation of appropriate resources are necessary to ensure appropriate care and management as well as to prevent further emergence of drug-resistance.
PMID: 22323578 [PubMed - as supplied by publisher] [Tuberculosis Pulmonary]