Clinical Features and Outcome of Multidrug-Resistant Osteoarticular Tuberculosis: A 12-Year Case Series from France.

Isabelle Bonnet (1) , Elie Haddad (2, 3) , Lorenzo Guglielmetti (1) , Pascale Bémer (4) , Louis Bernard (5) , Anne Bourgoin (6) , Rachel Brault (6) , Gaud Catho (7) , Eric Caumes (8) , Lélia Escaut (9, 10) , Eric Fourniols (11) , Mathilde Fréchet-Jachym (12) , Alice Gaudart (13) , Hélène Guillot (14) , Barthélémy Lafon-Desmurs (15) , Jean-Philippe Lanoix (16, 17) , Philippe Lanotte (5) , Adrien Lemaignen (5) , Bénédicte Lemaire (12) , Nadine Lemaître (16) , Christophe Michau (18) , Philippe Morand (19, 20) , Faïza Mougari (21, 22) , Dhiba Marigot-Outtandy (12) , Solene Patrat-Delon (23) , Thomas Perpoint (7) , Caroline Piau (23) , Valérie Pourcher (8, 3) , Virginie Zarrouk (24, 22) , Valérie Zeller (25) , Nicolas Veziris (1, 26, 27, 28, 29, 30) , Stéphane Jaureguiberry (31, 8, 3, 2) , Alexandra Aubry (1)

1 CIMI - Centre d'Immunologie et des Maladies Infectieuses
2 CHU Pitié-Salpêtrière [AP-HP]
3 iPLESP - Institut Pierre Louis d'Epidémiologie et de Santé Publique
4 CHU Nantes - Centre hospitalier universitaire de Nantes
5 CHRU Tours - Centre Hospitalier Régional Universitaire de Tours
6 CHU Poitiers - Centre hospitalier universitaire de Poitiers
7 HCL - Hospices Civils de Lyon
8 Service de Maladies Infectieuses et Tropicales [CHU Pitié-Salpêtrière]
9 Hôpital Bicêtre
10 Université Paris-Saclay
11 Service de Chirurgie Orthopédique et Traumatologique [CHU Pitié-Salpêtrière]
12 Centre Hospitalier de Bligny
13 Laboratoire de Bactériologie [CHU Nice]
14 Hôpital Robert Ballanger [Aulnay-sous-Bois]
15 Centre Hospitalier Tourcoing
16 CHU Amiens-Picardie
17 AGIR - Agents infectieux, résistance et chimiothérapie - UR UPJV 4294
18 Centre hospitalier de Saint-Nazaire
19 Hôpital Cochin [AP-HP]
20 GHU AP-HP Centre Université de Paris
21 Hôpital Lariboisière-Fernand-Widal [APHP]
22 Université Sorbonne Paris Nord
23 CHU Pontchaillou [Rennes]
24 Hôpital Beaujon [AP-HP]
25 Groupe Hospitalier Diaconesses Croix Saint-Simon
26 CNR-MyRMA - Centre National de Référence des Mycobactéries et de la Résistance aux Antituberculeux [CHU Pitié-Salpêtrière]
27 CHU Saint-Antoine [AP-HP]
28 CHU Tenon [AP-HP]
29 CHU Trousseau [APHP]
30 CHU Rothschild [AP-HP]
31 AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre)

The optimal treatment for osteoarticular infection due to multidrug-resistant tuberculosis strains (MDR-OATB) remains unclear. This study aims to evaluate the diagnosis, management and outcome of MDR-OATB in France. We present a case series of MDR-OATB patients reviewed at the French National Reference Center for Mycobacteria between 2007 and 2018. Medical history and clinical, microbiological, treatment and outcome data were collected. Twenty-three MDR-OATB cases were reported, representing 3% of all concurrent MDR-TB cases in France. Overall, 17 were male, and the median age was 32 years. Six patients were previously treated for TB, including four with first-line drugs. The most frequently affected site was the spine (n = 16). Bone and joint surgery were required in 12 patients. Twenty-one patients (91%) successfully completed the treatment with a regimen containing a mean of four drugs (range, 2-6) for a mean duration of 20 months (range, 13-27). Overall, high rates of treatment success were achieved following WHO MDR-TB treatment guidelines and individualized patient management recommendations by the French National TB Consilium. However, the optimal combination of drugs, duration of treatment and role of surgery in the management of MDR-OATB remains to be determined.

Mots clés: MDR-TB; XDR-TB; bone; spinal

Domaines: Médecine humaine et pathologie

Isabelle Bonnet, Elie Haddad, Lorenzo Guglielmetti, Pascale Bémer, Louis Bernard, et al.. Clinical Features and Outcome of Multidrug-Resistant Osteoarticular Tuberculosis: A 12-Year Case Series from France.. Microorganisms, 2022, 10 (6), ⟨10.3390/microorganisms10061215⟩. ⟨hal-03711168⟩