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The Relationship Between Fluoroquinolone Drug Exposure and Fluoroquinolone Resistance in Patients With Active Pulmonary Tuberculosis FREE TO VIEW

Serir Özkan, MD; Rahime Aydin Kayali, MD; Can Bicmen, MD; Onur Fevzi Erer, MD; Sevket Dereli, MD
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Izmir Teaching Hospital for Thoracic Medicine and Surgery, Izmir, Turkey

Chest. 2015;148(4_MeetingAbstracts):173A. doi:10.1378/chest.2259036
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SESSION TITLE: Tuberculosis Global Case Reports

SESSION TYPE: Global Case Report Poster

PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM

INTRODUCTION: The previous investigations suggest that empirical treatment with fluoroquinolones (FQ) before the diagnosis of tuberculosis (TB) is associated with a higher risk of FQ-resistant TB. The first aim of this study is to investigate whether treatment with FQs before TB diagnosis is associated with a high risk of developing FQ-resistant TB. The second aim is to assess the FQ resistance rate in newly diagnosed TB patients.

CASE PRESENTATION: Method: This study approved by local review board (326-2013). In this retrospective case-control study, 132 consecutive patients with newly diagnosed active pulmonary TB were obtained between 1 January - 31 December 2013. All of these patients were searched about FQs exposure a year before TB diagnosis. FQ exposure was assessed by linkage with medical records and medical history of patients and pharmacy registers obtained from social security institution. Thus, two study groups were selected from these TB cohort. Group A included 30 patients who had FQ drug exposure a year before diagnosis. Group B included 30 patients who had not FQ drug exposure a year before diagnosis. The demographic characteristics of patients who had and patients who had not FQ exposure were similar. The susceptibility tests of M. tuberculosis isolated from sputum were performed for first line TB drugs (isoniazid, rifampin, ethambutol and streptomycin) and FQs embracing ofloxacin and moxifloxacin. All patients were treated with standart anti tb therapy including isoniazid, rifampin, ethambutol and pyrazinamide Results: Thirty (22 %) patients of study cohort had FQ drug exposure a year before TB diagnosis. There were 13 (21.6 %) female, and 47 (78.3 %) male patients in two study groups. The median duration of FQ exposure was 13.7 ± 2.21 (min: 7, max: 56) days. Testing of M. tuberculosis revealed that all isolates were susceptible to isoniazid, rifampin, ethambutol and streptomycin. Two (6.66%) FQ-exposed patients had FQ resistant isolates in Group A. However, there was no significant difference for FQ resistance between two groups (p= 0.154) .

DISCUSSION: FQs have the potantial to become a part of future first-line anti TB regimen. The use of FQs to treat lower respiratory tract infections may cause selection of FQ resistant TB when TB is misdiagnosed. Migliori et al (1), report that TB patients had a three-fold higher risk of having FQ-resistant TB when prescribed FQs before TB diagnosis. Chen et al (2) also report that empirical prescriptions of FQs for pneumonia are associated with a higher risk of developing FQ resistant-TB. In this investigation, study cohort were assessed for FQ exposure a year before TB diagnosis. The rates of FQ exposure and FQ resistance in patients with newly diagnosed TB are 22 % and 3.3 % , respectively. According to previous reports, the rates of FQ resistance among patients newly diagnosed with TB has ranged from 0.15 to 3.6 (3). There were no significant relationship between FQ drug exposure and FQ resistance in our study. However, two patients who had FQ drug exposure had FQ resistant isolates.

CONCLUSIONS: There were several findings of this study. First, the part of patients with newly diagnosed TB who had FQ drug exposure before diagnosis was high. More judicious use of FQ monotherapy should be considered. There is a need to make a differential diagnosis for persons with signs and symptoms consistent with TB. Second, the rate of M.tuberculosis isolates with FQ resistance was 3.3 %. Our analysis revealed no significantly correlation between FQ exposure and FQ resistance. However 2 patients who had FQ exposure had FQ resistant isolates. So this is noteworthy for the relationship between FQ exposure and resistance.

Reference #1: Migliori GB, Langendam MW, D'Ambrossio L., et al. Protecting the tuberculosis drug pipeline: stating the case for the rational use of fluoroquinolones. Eur Respir J 2012; 40: 814-822

Reference #2: Chen TC, Lu PL, Lin CY, Lin WR, Chen YH. Fluoroquinolones are associated with delayed treatment and resistance in tuberculosis: a systemic review and meta-analysis. Int J Infect Dis 2011; 15: e211-e216

Reference #3: Devasia RA, Blackman A, Gebretsadik T, et al. Fluoroquinolone resistance in Mycobacterium tuberculosis. Am J Respir Crit Care Med 2009; 180: 365-370

DISCLOSURE: The following authors have nothing to disclose: Serir Özkan, Rahime Aydin Kayali, Can Bicmen, onur fevzi erer, sevket dereli

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