Emory University School of Medicine, Atlanta, GA, USA.
National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia.
Int J Tuberc Lung Dis. 2021 Aug 1;25(8):632-639. doi: 10.5588/ijtld.21.0159.
National Center for Tuberculosis and Lung Diseases (NCTLD), Tbilisi, Georgia. To determine clinical outcomes of patients with tuberculous meningitis (TBM) treated with an intensified regimen including a fluoroquinolone (FQ) and an injectable agent. Prospective cohort of patients aged ≥16 years initiating treatment for TBM at the NCTLD from January 2018 to December 2019. Treatment outcomes and neurologic disability at 1, 6 and 12 months after treatment initiation were assessed. Among 77 patients with median follow-up time of 363 days (IQR 269-374), 97% received a FQ, 62% an injectable agent, 44% linezolid and 39% a carbapenem. Fifty-seven patients (74%) successfully completed treatment, 2 (2.6%) had treatment failure, 6 (7.8%) died, and the remainder (12%) were lost to follow up. Among 11 patients treated for multidrug-resistant TBM, the median follow-up time was 467 days and one patient (8%) died. Regarding neurologic outcomes, 14/76 (18%) patients had Modified Rankin Scores of 0 at baseline, improving to 85% (56/66) and 94% (47/50) at 6 and 12 months, respectively. Intensified multidrug treatment regimens including a FQ and an injectable agent in all patients and newly implemented drugs in patients with multidrug-resistant TBM resulted in low mortality and favorable neurologic outcomes.
格鲁吉亚第比利斯国家结核病和肺病中心（NCTLD）。旨在确定接受强化方案治疗的结核性脑膜炎（TBM）患者的临床结局，该方案包括氟喹诺酮类药物（FQ）和注射用药物。2018 年 1 月至 2019 年 12 月，在 NCTLD 开始治疗的年龄≥16 岁的 TBM 患者的前瞻性队列。评估治疗开始后 1、6 和 12 个月的治疗结局和神经残疾情况。在中位随访时间为 363 天（IQR 269-374）的 77 例患者中，97%接受了 FQ，62%接受了注射用药物，44%接受了利奈唑胺，39%接受了碳青霉烯类药物。57 例（74%）患者成功完成治疗，2 例（2.6%）治疗失败，6 例（7.8%）死亡，其余 12%患者失访。在 11 例耐多药 TBM 患者中，中位随访时间为 467 天，1 例（8%）患者死亡。关于神经结局，76 例患者中有 14 例（18%）患者基线改良 Rankin 评分（mRS）为 0，6 个月时改善为 85%（56/66），12 个月时改善为 94%（47/50）。在所有患者中使用强化多药治疗方案，包括 FQ 和注射用药物，并在耐多药 TBM 患者中使用新实施的药物，导致死亡率低且神经结局良好。
