Decreased mortality seen in rifampicin/multidrug-resistant tuberculous meningitis treated with linezolid in Shenzhen, China

Fang, Mu-Tong1; Su, You-Feng1; An, Hui-Ru2; Zhang, Pei-Ze1; Deng, Guo-Fang1; Liu, Hou-Ming1; Mao, Zhi1; Zeng, Jian-Feng1; Li, Guobao1; Yang, Qian-Ting1; Wang, Zhong-Yuan1,2

2021-09-28

10.1186/s12879-021-06705-4

BMC INFECTIOUS DISEASES   影响因子和分区

1471-2334

Background The morbidity of rifampicin/multidrug-resistant tuberculous meningitis (RR/MDR-TBM) has shown an increasing trend globally. Its mortality rate is significantly higher than that of non-rifampicin/multidrug-resistant tuberculous meningitis (NRR/MDR-TBM). This article aimed to explore risk factors related to RR/MDR-TBM, and compare therapeutic effects of linezolid (LZD)- and non-linezolid-containing regimen for RR/MDR-TB patients in Shenzhen city. Furthermore, we aimed to find a better therapy for pathogen-negative TBM with RR/MDR-TBM related risk factors. Methods We conducted a retrospective study enrolling 137 hospitalized cases with confirmed TBM from June 2014 to March 2020. All patients were divided into RR/MDR-TBM group (12 cases) and NRR/MDR-TBM group (125 cases) based on GeneXpert MTB/RIF and (or) phenotypic drug susceptibility test results using cerebral spinal fluid (CSF). The risk factors related to RR/MDR-TBM were investigated through comparing clinical and examination features between the two groups. The mortality rate of RR/MDR-TBM patients treated with different regimens was analyzed to compare their respective therapeutic effects. A difference of P < 0.05 was considered statistically significant. Results Most patients (111/137, 81%) were from southern or southwestern China, and a large proportion (72/137, 52.55%) belonged to migrant workers. 12 cases were RR/MDR-TBM (12/137, 8.8%) while 125 cases were NRR/MDR-TBM (125/137, 91.2%). The proportion of patients having prior TB treatment history in the RR/MDR-TBM group was significantly higher than that of the NRR/MDR-TBM group (6/12 vs. 12/125, 50% vs. 10.5%, P < 0.01). No significant difference was observed on other clinical and examination features between the two groups. Mortality was significantly lower in RR/MDR-TBM patients on linezolid-containing treatment regimen than those who were not (0/7 versus 3/5, 0% versus 60%, P = 0.045). Conclusions The main related risk factor of RR/MDR-TBM is the history of anti-tuberculosis treatment. Linezolid-containing regimen appears to lower mortality rate of RR/MDR-TBM significantly in our study. We think Linezolid should be evaluated prospectively in the treatment of RR/MDR-TBM.

Tuberculous meningitis Linezolid Blood-brain barrier Rifampicin multidrug-resistant TBM

SCI

英语

第一 ; 通讯

Guangdong Province Science and Technology Project[2020B1111170014] ; Shenzhen Fund for Guangdong Provincial High-level Clinical Key Specialties[SZGSP010]

Infectious Diseases

Infectious Diseases

WOS:000701048900001

BMC

IMMUNOLOGY

Web of Science

1.Southern Univ Sci & Technol, Shenzhen Peoples Hosp 3, Natl Clin Res Ctr Infect Dis Shenzhen, Guangdong Prov Clin Res Ctr Infect Dis TB, Shenzhen 518112, Peoples R China
2.Chinese Peoples Liberat Army Gen Hosp, TB Sect, Med Ctr 8, Beijing, Peoples R China

Fang, Mu-Tong,Su, You-Feng,An, Hui-Ru,et al. Decreased mortality seen in rifampicin/multidrug-resistant tuberculous meningitis treated with linezolid in Shenzhen, China[J]. BMC INFECTIOUS DISEASES,2021,21(1).

Fang, Mu-Tong.,Su, You-Feng.,An, Hui-Ru.,Zhang, Pei-Ze.,Deng, Guo-Fang.,...&Wang, Zhong-Yuan.(2021).Decreased mortality seen in rifampicin/multidrug-resistant tuberculous meningitis treated with linezolid in Shenzhen, China.BMC INFECTIOUS DISEASES,21(1).

Fang, Mu-Tong,et al."Decreased mortality seen in rifampicin/multidrug-resistant tuberculous meningitis treated with linezolid in Shenzhen, China".BMC INFECTIOUS DISEASES 21.1(2021).