Background: Tuberculous meningitis (TBM) caused by Mycobacterium tuberculosis resistant to antituberculosis drugs is an increasingly common clinical problem. This study aimed to evaluate drug resistance profiles of TBM isolates in adult patients in nine European countries involving 32 centers to provide insight into the empiric treatment of TBM.
Methods: Mycobacterium tuberculosis was cultured from the cerebrospinal fluid (CSF) of 142 patients and was tested for susceptibility to first-line antituberculosis drugs, streptomycin (SM), isoniazid (INH), rifampicin (RIF) and ethambutol (EMB).
Results: Twenty of 142 isolates (14.1 %) were resistant to at least one antituberculosis drug, and five (3.5 %) were resistant to at least INH and RIF, [multidrug resistant (MDR)]. The resistance rate was 12, 4.9, 4.2 and 3.5 % for INH, SM, EMB and RIF, respectively. The monoresistance rate was 6.3, 1.4 and 0.7 % for INH, SM and EMB respectively. There was no monoresistance to RIF. The mortality rate was 23.8 % in fully susceptible cases while it was 33.3 % for those exhibiting monoresistance to INH, and 40 % in cases with MDR-TBM. In compared to patients without resistance to any firstline drug, the relative risk of death for INH-monoresistance and MDR-TBM was 1.60 (95 % CI, 0.38-6.82) and 2.14 (95 % CI, 0: 34-13: 42), respectively.
Conclusion: INH-resistance and MDR rates seemed not to be worrisome in our study. However, considering their adverse effects on treatment, rapid detection of resistance to at least INH and RIF would be most beneficial for designing anti-TB therapy. Still, empiric TBM treatment should be started immediately without waiting the drug susceptibility testing.
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[Ozkutuk, Nuri] Celal Bayar Univ, Sch Med, Dept Med Microbiol, Manisa, Turkey.
[Erdem, Hakan; Gul, Hanefi Cem; Savasci, Umit] Gulhane Mil Med Acad, Dept Infect Dis & Clin Microbiol, Ankara, Turkey.
[Johansen, Isik Somuncu] Odense Univ Hosp, Dept Infect Dis Q, DK-5000 Odense, Denmark.
[Civljak, Rok] Univ Zagreb, Sch Med, Dept Infect Dis, Dr Fran Mihaljev Univ Hosp Infect Dis, Zagreb 41001, Croatia.
[Inal, Ayse Seza] Cukurova Univ, Sch Med, Dept Infect Dis & Clin Microbiol, Adana, Turkey.
[Kayabas, Uner] Inonu Univ, Sch Med, Dept Infect Dis & Clin Microbiol, Malatya, Turkey.
[Kursun, Ebru] Baskent Univ, Sch Med, Dept Infect Dis & Clin Microbiol, Adana, Turkey.
[Elaldi, Nazif] Cumhuriyet Univ, Sch Med, Dept Infect Dis & Clin Microbiol, Sivas, Turkey.
[Savic, Branislava] Univ Belgrade, Natl Reference Lab TB, Inst Microbiol & Immunol, Fac Med, Belgrade, Serbia.
[Simeon, Soline] Univ Hosp Pontchaillou, Dept Infect & Trop Dis, Rennes, France.
[Yilmaz, Emel] Uludag Univ, Sch Med, Dept Infect Dis & Clin Microbiol, Bursa, Turkey.
[Dulovic, Olga] Univ Belgrade, Clin Infect & Trop Dis, Clin Ctr Serbia, Fac Med, Belgrade, Serbia.
[Lakatos, Botond] St Laszlo Hosp, Dept Infect Dis, Budapest, Hungary.
[Sipahi, Oguz Resat] Ege Univ, Dept Infect Dis & Clin Microbiol, Sch Med, Izmir, Turkey.
[Sunbul, Mustafa] Ondokuz Mayis Univ, Sch Med, Dept Infect Dis & Clin Microbiol, Samsun, Turkey.
[Yemisen, Mucahit] Istanbul Univ, Cerrahpasa Med Sch, Dept Infect Dis & Clin Microbiol, Istanbul, Turkey.
[Alabay, Selma; Ulu-Kilic, Aysegul] Erciyes Univ, Sch Med, Dept Infect Dis & Clin Microbiol, Kayseri, Turkey.
[Beovic, Bojana] Univ Med Ctr, Dept Infect Dis, Ljubljana, Slovenia.
[Cag, Yasemin] Lutfi Kirdar Training & Res Hosp, Dept Infect Dis & Clin Microbiol, Istanbul, Turkey.
[Catroux, Melanie] Univ Poitiers Hosp, Dept Infect Dis, Poitiers, France.
[Dragovac, Gorana] Univ Novi Sad, Fac Med, Dept Prevent & Control Dis, IPH Vojvodina, Novi Sad 21000, Serbia.
[Deveci, Ozcan; Tekin, Recep] Dicle Univ, Sch Med, Dept Infect Dis & Clin Microbiol, Diyarbakir, Turkey.
[Sengoz, Gonul] Haseki Training & Res Hosp, Dept Infect Dis & Clin Microbiol, Istanbul, Turkey.
[Andre, Katell] Dax Hosp, Dept Infect Dis, Dax, France.
[Harxhi, Arjan] Univ Hosp Ctr Tirana, Infect Dis Serv, Tirana, Albania.
[Hansmann, Yves] Univ Hosp, Dept Infect Dis, Strasbourg, France.
[Oncu, Serkan] Adnan Menderes Univ, Sch Med, Dept Infect Dis & Clin Microbiol, Aydin, Turkey.
[Kose, Sukran] Tepecik Training & Res Hosp, Dept Infect Dis & Clin Microbiol, Izmir, Turkey.
[Oncul, Oral] GATA Haydarpasa Training Hosp, Dept Infect Dis & Clin Microbiol, Istanbul, Turkey.
[Parlak, Emine] Ataturk Univ, Sch Med, Dept Infect Dis & Clin Microbiol, Erzurum, Turkey.
[Sener, Alper] Onsekiz Mart Univ, Sch Med, Dept Infect Dis & Clin Microbiol, Canakkale, Turkey.
[Yilmaz, Gulden] Ankara Univ, Sch Med, Dept Infect Dis & Clin Microbiol, TR-06100 Ankara, Turkey.
[Vahaboglu, Haluk] Medeniyet Univ, Goztepe Training & Res Hosp, Dept Infect Dis & Clin Microbiol, Istanbul, Turkey.