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Volume 30, Number 4—April 2024
Research Letter

Drug-Resistant Tuberculosis, Georgia, Kazakhstan, Kyrgyzstan, Moldova, and Ukraine, 2017–2022

Victor Naestholt DahlComments to Author , Tetiana Butova, Alex Rosenthal, Alina Grinev, Andrei Gabrielian, Sergo Vashakidze, Natalia Shubladze, Bekzat Toxanbayeva, Lyailya Chingissova, Valeriu Crudu, Dumitru Chesov, Gulmira Kalmambetova, Gulbarchyn Saparova, Christian Morberg Wejse, Dmytro Butov, and Ukraine TB-Portal Study Group
Author affiliations: Aarhus University Hospital, Aarhus, Denmark (V.N. Dahl, C.M. Wejse); Merefa Central District Hospital, Merefra, Ukraine (T. Butova); National Institutes of Health, Bethesda, Maryland, USA (A. Rosenthal, A. Grinev, A. Gabrielian); National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia (S. Vashakidze, N. Shubladze); National Scientific Center of Phthisiopulmonology, Almaty, Kazakhstan (B. Toxanbayeva, L. Chingissova); Institute of Phthisiopneumology, Chisinau, Moldova (V. Crudu); State University of Medicine and Pharmacy, Chisinua (D. Chesov); National TB Program, Bishkek, Kyrgyzstan (G. Kalmambetova, G. Saparova); Kharkiv National Medical University, Kharkiv, Ukraine (D. Butov)

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Figure

Treatment outcomes for patients with MDR, pre-XDR, and XDR tuberculosis (TB) in Georgia, Kazakhstan, Kyrgyzstan, Moldova, and Ukraine during 2017–2022 by current (A) and former (B) definitions of drug resistance. We excluded 9 patients with an unevaluated outcome and 15 patients without outcome data. TB treatment outcomes were defined according to WHO recommendations (6,7). MDR TB was defined as TB caused by Mycobacterium tuberculosis strains resistant to at least both rifampin and isoniazid (1). We used the current definition of pre-XDR TB from 2021 as TB caused by M. tuberculosis strains fulfilling the definition of MDR TB but including resistance to any fluoroquinolone (levofloxacin or moxifloxacin), whereas XDR TB was defined as additional resistance to >1 group A drug (bedaquiline or linezolid) (A). The previous, informal definition of pre-XDR TB was MDR TB plus additional resistance to any fluoroquinolone, or any second-line injectable, but not both, whereas the definition of XDR TB from 2006 was TB resistant to any fluoroquinolone and to >1 of 3 second-line injectable drugs (capreomycin, kanamycin, and amikacin), in addition to MDR TB. MDR, multidrug-resistant; XDR, extensively drug-resistant.

Figure. Treatment outcomes for patients with MDR, pre-XDR, and XDR tuberculosis (TB) in Georgia, Kazakhstan, Kyrgyzstan, Moldova, and Ukraine during 2017–2022 by current (A) and former (B) definitions of drug resistance. We excluded 9 patients with an unevaluated outcome and 15 patients without outcome data. TB treatment outcomes were defined according to WHO recommendations (6,7). MDR TB was defined as TB caused by Mycobacterium tuberculosis strains resistant to at least both rifampin and isoniazid (1). We used the current definition of pre-XDR TB from 2021 as TB caused by M. tuberculosis strains fulfilling the definition of MDR TB but including resistance to any fluoroquinolone (levofloxacin or moxifloxacin), whereas XDR TB was defined as additional resistance to >1 group A drug (bedaquiline or linezolid) (A). The previous, informal definition of pre-XDR TB was MDR TB plus additional resistance to any fluoroquinolone, or any second-line injectable, but not both, whereas the definition of XDR TB from 2006 was TB resistant to any fluoroquinolone and to >1 of 3 second-line injectable drugs (capreomycin, kanamycin, and amikacin), in addition to MDR TB. MDR, multidrug-resistant; XDR, extensively drug-resistant.

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