Relapse and Emergent Resistance With Novel Short-Course Regimens for Multidrug-Resistant Tuberculosis, United States, 2022–2024
Year: 2025
Type: article
Study design: Case Report
Abstract: Background Bedaquiline, pretomanid, and linezolid with or without moxifloxacin (BPaL/M) are recommended oral 6-month treatment regimens for multidrug- or rifampin-resistant (MDR/RR) tuberculosis (TB). Since the US rollout of these regimens in 2019, the US Centers for Disease Control and Prevention (CDC) and partners have identified patients who failed or relapsed on these regimens. Methods Here, we report a case series of US patients with TB treated with BPaL/M-containing regimens, who experienced adverse outcomes during the period 2022‒2024, including drug resistance, relapse, and treatment failure. Results Clinical and public health outcomes were significant for US patients reported. There were 8 patients identified (n = 8). 5 (62.5%) were male, with a median age 57 years, 2 (25%) were previously treated for TB, and 8 (100%) presented with cavitary disease. This included a patient who died from infectious TB with acquired resistance after exposing over 100 healthcare workers, a waitress who was found to have highly infectious TB at the time of her relapse, and a son who contracted Mycobacterium tuberculosis (Mtb) with reduced activity to bedaquiline from his mother in a household transmission event. Conclusions These patients highlight consequences, both for the individual and public health, of relapse and treatment failure in real-life operational settings that may not be readily evident in well-controlled and well-resourced clinical trials. Despite the advent of shorter and better tolerated bedaquiline-based regimens, US clinicians continue to face challenges in managing drug-resistant TB. These data support the need for expert management of these patients beyond routine TB care, as well as the need for close monitoring and follow-up months after treatment completion.
Source: Open Forum Infectious Diseases
DOI: 10.1093/ofid/ofaf786
Authors: Rina Liang, James C M Brust, Caitlin Reed, Vincent Escuyer, Derek T Armstrong, Nicole Parrish, Patrick Valois, Marie-Claire Rowlinson, Atanaska Marinova-Petkova, Gregory P Bisson, Sarah M Labuda, Angel Colon-Semidey, Connie A Haley, David Ashkin, Charles A Peloquin, Alfred Lardizabal, Amee Patrawalla, Alice Cuenca, Michelle K Haas, Richard Brostrom, Chima Mbakwem, Marcos C Schechter, Susan M Ray, Jason Cummins, Barbara Cahill, Katherine Arn, Lisa L Chen, John W Wilson, Neela D Goswami
Institutions: Albert Einstein College of Medicine, Montefiore Medical Center, Centers for Disease Control and Prevention, New York State Department of Health, Wadsworth Center, Johns Hopkins University, Johns Hopkins Medicine, Florida Department of Health, Philadelphia Department of Public Health, Puerto Rico Department of Health, University of Florida, Rutgers, The State University of New Jersey, Department of Public Health and Social Services, University of California, San Francisco, Emory University, Georgia Department of Public Health, Tennessee Department of Health, Mayo Clinic
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,053
OpenAlex ID: W7124258945