Efficacy of surgical intervention in modern complex treatment for tuberculosis with multidrug-resistant and extensively drug-resistant pathogen

Background. One of the top priorities in phthisiology at present is the problem of tuberculosis treatment with multiple drug resistance (MDR) and extensive drug resistance (XDR) Mycobacterium tuberculosis (MBT). The unsatisfactory results of etiotropic chemotherapy associated with a large number of factors determine the need for surgical treatment. The effectiveness of surgical treatment and the advantages of using surgical techniques (in combination with chemotherapy) compared to the use of chemotherapy alone, it is currently poorly understood and undoubtedly requires research at various levels.

The aim. Evaluation of the effectiveness and determination of optimal timing and risks of surgical intervention in the framework of complex treatment of tuberculosis with MDR/XDR pathogen using modern chemotherapy regimens.

Materials and methods. The data on the treatment outcomes of 71 patients with MDR/XDR pathogen after surgery who received identical modern chemotherapy regimens (including bedaquiline, linezolid, fluoroquinolones, cycloserine) with a catamnesis of sufficient duration (at least 5 years) were analyzed.

Results. Successful treatment outcome (cure with transfer to the III GDN or de-registration) was registered in 83.1 % (95% CI 72.6-90.2 %). One independent risk factor for an unfavorable outcome was identified - the presence of behavioral characteristics of the patient, indicating his low adherence to treatment (p = 0.014). For relapse, the only independent risk factor was taking less than 90 doses of drugs according to the treatment regimen for drug-resistant tuberculosis, including bedaquiline and linezolid before surgery (p = 0.013).

Conclusion. The high efficiency of complex treatment during surgical intervention against the background of MDR/XDR-tuberculosis chemotherapy regimens with the inclusion of bedaquiline and linezolid has been shown. The priority role of working with patients' commitment to treatment for the prevention of adverse outcomes has been confirmed. The optimal duration of preoperative chemotherapy according to the “new” regimens (3 months or more) has been determined.

1. Vasilyeva IA, Belilovsky EM, Borisov SE, Sterlikov SА. Multi drug resistant tuberculosis in the countries of the outer world and in the Russian Federation. Tuberculosis and Lung Diseases. 2017; 95(11): 5-17. (In Russ.). doi: 10.21292/2075-1230-2017-95-11-5-17

2. Chiang CY, Yew WW. Multidrug-resistant and extensively drug-resistant tuberculosis. Int J Tuberc Lung Dis. 2009; 13(3): 304-311.

3. Sotgiu G, Ferrara G, Matteelli A, Richardson MD, Centis R, Ruesch-Gerdes S, et al. Epidemiology and clinical management of XDR-TB: a systematic review by TBNET. The European respiratory journal. 2009; 33(4): 871-881. doi: 10.1183/09031936.00168008

4. Vasilyeva IA, Samoylova AG, Zimina VN, Lovacheva OV, Abramchenko AV. Chemotherapy for Tuberculosis in Russia - the Story Continues. Tuberculosis and Lung Diseases. 2023; 101(2): 8-12. (In Russ.). doi: 10.58838/2075-1230-2023-101-2-8-12

5. Borisov SE, Dheda K, Enwerem M, Romero Leyet R, D'Ambrosio L, Centis R, et al. Effectiveness and safety of bedaquiline-containing regimens in the treatment of MDR- and XDR-TB: a multicentre study. The European respiratory journal. 2017; 49(5): 1700387. doi: 10.1183/13993003.00387-2017

6. Migliori GB, Tiberi S, Zumla A, Petersen E, Chakaya JM, Wejse C, et al. Members of the Global Tuberculosis Network. MDR/XDR-TB management of patients and contacts: Challenges facing the new decade. The 2020 clinical update by the Global Tuberculosis Network. Int J Tuberc Lung Dis. 2020; 92S: S15-S25. doi: 10.1016/j.ijid.2020.01.042

7. Kilani T, Boudaya MS, Zribi H, Ouerghi S, Marghli A, Mestiri T, et al. La chirurgie dans la tuberculose thoracique [Surgery for thoracic tuberculosis]. Revue de pneumologie Clinique. 2015; 71(2-3): 140-158. doi: 10.1016/j.pneumo.2014.03.005

8. Marrone MT, Venkataramanan V, Goodman M, Hill AC, Jereb JA, Mase SR. Surgical interventions for drug-resistant tuberculosis: a systematic review and meta-analysis. Int J Tuberc Lung Dis. 2013; 17(1): 6-16. doi: 10.5588/ijtld.12.0198

9. WHO. Global tuberculosis report 2024. Geneva: World Health Organization; 2024. Licence: CC BY-NC-SA 3.0 IGO. URL: https://www.who.int/teams/global-programme-on-tuberculosis-and-lung-health/tb-reports/global-tuberculosis-report-2024. [date of access: July 19, 2025].

10. Clinical recommendations “Tuberculosis in adults”, 2024; 32-35. (In Russ.). URL: https://tub-spb.ru/wp-content/uploads/2022/06/klinicheskie-rekomendaczii-tuberkulez-u-vzroslyh-utv.-minzdravom-rossii.pdf. [date of access: July 19, 2025].

11. Thoracicsurgery. National clinical recommendations. Yablonsky PK, eds., Moscow, GEOTAR-Media Publ., 2014, 160 p. (In Russ.).

12. Laniado-Laborîn R. Surgical Treatment in Tuberculosis / In: Tuberculosis: a clinical practice guide. Bentham Science Publishers. 2020; 145-154. doi: 10.2174/9789811488511120010016

13. Yablonskiy PK, Sokolovich EG, Avetisyan AO, Vasil'ev IV. The role of thoracic surgery in pulmonary tuberculosis treatment (review and the authors' observations). Meditsinskiy Al'yans. 2014; 3: 4-10. (In Russ.).

14. Edict No. 951 by Heath-Min of the Russian Federation as of December 29, 2014. “On Approval of Guidelines for Improvement of Respiratory Tuberculosis Diagnostics and Treatment”. (In Russ.).

15. Federal recommendations for diagnostics and treatment of respiratory tuberculosis]. Moscow, 2015.-p. (In Russ.).

16. World Health Organization: Adherence to long-term therapies, evidence for action. Geneva: World Health Organization; 2003. URL: http: //www.who.int2. [date of access: July 19, 2025]

17. Giller DB, Saenko SS, Shcherbakova GV, Enilenis II, Kesaev OSh, Gerasimov AN, et al. Surgical treatment of multi- and extensively drug-resistant pulmonary tuberculosis. CTRI Bulletin. 2024; 8(4): 5-16 (In Russ.) doi: 10.57014/2587-6678-2024-8-4-5-16

18. Lebed LV, Poddubnaya LV. Comparative analysis of the effectiveness of treatment of tuberculosis patients with different adherence to treatment. Bulletin of Hygiene and Epidemiology. 2019; 23(4): 339-343 (In Russ.).