Towards tailored regimens in the treatment of drug-resistant tuberculosis: A retrospective study in two Italian reference Centres

Niccolò Riccardi, Riccardo Alagna, Laura Saderi, Maurizio Ferrarese, Paola Castellotti, Ester Mazzola, Saverio De Lorenzo, Pietro Viggiani, Zarir Udwadia, Giorgio Besozzi, Daniela Cirillo, Giovanni Sotgiu, Luigi Codecasa

Research output: Contribution to journalArticlepeer-review


Background: The increased incidence of drug-resistant TB is a major challenge for effective TB control. Limited therapeutic options and poor treatment outcomes of DR-TB may increase drug-resistance rates. The objective of the study is to retrospectively compare MDR-TB and pre-XDR-TB treatment regimens and outcomes in two large TB reference centres in Italy from January 2000 to January 2015. Methods: A retrospective, multicentre study was conducted at the Regional TB Reference Centre Villa Marelli Institute (Milan) and at the Reference Center for MDR-TB and HIV-TB, Eugenio Morelli Hospital (Sondalo). The supra-national Reference Laboratory in Milan performed DST. Inclusion criteria were: age ≥ 18 and culture-confirmed diagnosis of MDR- or pre-XDR TB. Chi-square or Fisher exact test was used to detect differences in the comparison between treatment outcomes, therapeutic regimens, and drug-resistances. Computations were performed with STATA 15. Results: A total of 134 patients were selected. Median (IQR) age at admission was 33 (26-41) years and 90 patients (67.2%) were male. Pulmonary TB was diagnosed in 124 (92.5%) patients. MDR- and pre-XDR-TB cases were 91 (67.9%) and 43 (32.1%), respectively. The WHO shorter MDR-TB regimen could have been prescribed in 16/84 (19.1%) patients. Treatment success was not statistically different between MDR- and pre-XDR-TB (81.3% VS. 81.4%; P = 0.99). Mortality in MDR-TB and pre-XDR-TB groups was 4.4 and 9.3%, respectively (P = 0.2). Median duration of treatment was 18 months and a total of 110 different regimens were administered. Exposure to linezolid, meropenem, and amikacin was associated with a better outcome in both groups (P = 0.001, P < 0.001, and P = 0.004, respectively). Conclusions: Tailored treatment regimens based on DST results can achieve successful outcomes in patients with pre-XDR-TB.

Original languageEnglish
Article number564
JournalBMC Infectious Diseases
Issue number1
Publication statusPublished - Jun 28 2019


  • DST
  • Individualized regimen
  • Pre-XDR-TB
  • Tuberculosis

ASJC Scopus subject areas

  • Infectious Diseases


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