title: Early results of systematic drug susceptibility testing in pulmonary tuberculosis retreatment cases in Cameroon.
abstract: BACKGROUND
  The number of pulmonary tuberculosis (PTB) patients reported with resistance to first-line anti-tuberculosis drugs after a standardized retreatment regimen in Cameroon is increasing. Hence, the National Tuberculosis Control Program (NTP) implemented, in one of the ten Regions of the country, a pilot programme aimed at performing routine drug susceptibility testing (DST) for previously treated PTB cases. The objectives of the programme were to evaluate the feasibility of monitoring drug resistance among retreatment cases under programme conditions and to measure the presence and magnitude of anti-TB drug resistance in order to inform NTP policies.
  
  
  RESULTS
  This retrospective cohort study was conducted in the Littoral Region of Cameroon in 2009. It included all sputum smear positive (SM+) PTB cases registered for retreatment. TB cases were identified and classified according to World Health Organization (WHO) recommendations for national TB programs. Bacterial susceptibility testing to first-line anti-TB drugs was performed using standard culture methods. In 2009, 5,668 TB cases were reported in the Littoral Region, of which 438 (7.7%) were SM + PTB retreatment cases. DST results were available for 216 (49.4%) patients. Twenty six patients (12%) harbored multi-drug resistant (MDR) strains. Positive treatment outcome rates were particularly low in retreatment patients with MDR-TB (46.2%; 95% CI: 27.1-66.3). Thirteen MDR-TB patients were treated using a standardized MDR treatment regimen. Delivery of laboratory results took on average 17 (12-26) weeks.
  
  
  CONCLUSIONS
  WHO-recommended routine DST in retreatment patients seems feasible in Cameroon. However, coverage needs to be improved through better management. Moreover, diagnostic delay should be shortened by introducing more rapid diagnostic tools. The high risk of MDR in standard regimen failure cases virtually rules out the standard retreatment regimen for such patients without prior DST.
authors.affiliation: German Development Cooperation (GIZ), P,O, Box 7814, Yaounde, Cameroon. juergennoeske@yahoo.fr
authors.forename: Jürgen
authors.initials: J
authors.lastname: Noeske
authors.forename: Natascha
authors.initials: N
authors.lastname: Voelz
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Fon
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Abena Foe
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000494:pharmacology* / Q000627:therapeutic use; D002163:Cameroon; D024901:Drug Resistance, Multiple, Bacterial / Q000187:drug effects; D005240:Feasibility Studies; D005260:Female; D024841:Fluoroquinolones / Q000494:pharmacology / Q000627:therapeutic use; D000077734:Gatifloxacin; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests / Q000379:methods*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods; D010865:Pilot Projects; D019233:Retreatment; D012189:Retrospective Studies; D012293:Rifampin / Q000494:pharmacology / Q000627:therapeutic use; D013183:Sputum / Q000382:microbiology*; D013307:Streptomycin / Q000494:pharmacology / Q000627:therapeutic use; D013997:Time Factors; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents; D024841:Fluoroquinolones; D000077734:Gatifloxacin; D012293:Rifampin; D013307:Streptomycin