Extensively Drug-Resistant TB Outcomes Remain Poor in Europe
Only four out of 10 patients with extensively drug-resistant tuberculosis in Europe achieved successful treatment outcomes, a rate markedly lower than that for other forms of drug-resistant tuberculosis and comparable with cure rates from the pre-antibiotic era.
METHODOLOGY:
Researchers conducted a retrospective observational cohort study across 16 countries of the World Health Organization (WHO) European Region to evaluate treatment outcomes in 188 patients (median age, 42 years; 79.3% men) with extensively drug-resistant tuberculosis.
Data collected included patient characteristics, disease localisation, prior treatments, phenotypic and genotypic drug susceptibility testing results, and treatment regimens.
Treatment outcomes were categorised as successful, failure (microbiological or clinical reasons including regimen changes), lost to follow-up (treatment interrupted for 2 or more months), or not evaluated.
TAKEAWAY:
Among the 188 patients with extensively drug-resistant tuberculosis, 48.4%, 34.0%, and 17.6% of Mycobacterium tuberculosis strains were resistant to bedaquiline alone, linezolid alone, and both drugs, respectively.
Among 156 patients with available data for treatment outcomes, 40.2% (95% CI, 28.4%-53.2%) achieved successful outcomes in a pooled analysis accounting for between-country heterogeneity.
Patients with extensively drug-resistant tuberculosis had lower pooled success rates (P < .0001) and significantly higher pooled rates of treatment failure and death (P < .0001 and P = .008, respectively) than those with multidrug-/rifampicin-resistant or preextensively drug-resistant tuberculosis.
The likelihood of an unsuccessful outcome decreased with each additional effective drug in the regimen (P = .026) but increased among patients treated in upper-middle-income countries compared with that among those treated in high-income countries (P < .001).
IN PRACTICE:
"[The study] findings underscore the need for improved, rapid DST [drug susceptibility testing] tools and effective, shorter treatment regimens for extensively drug-resistant tuberculosis," the authors wrote.
SOURCE:
This study was led by Yousra Kherabi, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France, and Ole Skouvig Pedersen, Aarhus University Hospital, Aarhus, Denmark. It was published online on July 15, 2025, in The Lancet Regional Health - Europe.
LIMITATIONS:
The coverage of the WHO European Region was limited. Most of the participating centres were specialist or referral centres, which may have introduced selection bias and limiting generalisability. Although the use of WHO-defined outcomes simplified data collection, it constrained a detailed understanding of treatment failures. Moreover, individual-level data were available only for patients with extensively drug-resistant tuberculosis, which may have introduced confounding from unmeasured patient-level factors.
DISCLOSURES:
This study did not receive any funding. One author reported serving as a co-principal investigator of clinical trials testing new regimens for multidrug-resistant tuberculosis, and some authors reported receiving honoraria for speaking engagements or serving on advisory boards of various pharmaceutical companies.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
Gizmodo
15 minutes ago
- Gizmodo
Lightning Kills Way More Trees Than Anyone Thought, New Research Suggests
We've all seen dramatic footage of lightning striking a mighty tree, its branches going up in flames. But how often does this actually happen? Researchers didn't know how much lightning impacted forests—until now. Researchers at the Technical University of Munich (TUM) have developed a computer model to provide what they claim to be the first estimate of lightning's impact on forest ecosystems around the world. According to their study, lightning affects forests more than previously thought. Specifically, they suggest that around 320 million trees die each year from lightning strikes, not including the trees that die in lightning-induced wildfires. 'Lightning is an important yet often overlooked disturbance agent in forest ecosystems,' the researchers explained in the study, published last month in the journal Global Change Biology. To make their estimate, they integrated observational data and global lightning patterns into a well-known global vegetation simulation. The computer model indicates that trees killed by lightning represent 2.1% to 2.9% of all plant biomass loss annually. While plants and trees absorb CO2 through photosynthesis during their lifetimes, they release a significant amount of it back into the atmosphere when they die and decay. As such, these figures are crucial to better understanding Earth's carbon cycling. With the combined model, 'we're now able not only to estimate how many trees die from lightning strikes annually, but also to identify the regions most affected and assess the implications for global carbon storage and forest structure,' Andreas Krause, lead author of the study and researcher at the Chair of Land Surface-Atmosphere Interactions, explained in a TUM statement. The biomass decay caused by the lightning-killed trees is estimated to emit between 770 million and 1.09 billion tons of carbon dioxide annually. According to the researchers, this is surprisingly high. For comparison, living plants burned in wildfires release around 1.26 billion tons of CO2 every year. Both of these figures, however, are dwarfed by the total wildfires CO2 emissions (including the combustion of deadwood and soil material), which is approximately 5.85 billion tons per year. 'Most climate models project an increase in lightning frequency in the coming decades, so it's worth paying closer attention to this largely overlooked disturbance,' said Krause. 'Currently, lightning-induced tree mortality is highest in tropical regions. However, models suggest that lightning frequency will increase primarily in middle- and high-latitude regions, meaning that lightning mortality could also become more relevant in temperate and boreal forests.' The researchers argue that ecosystem models need to account for lightning mortality in order to better predict vegetation dynamics. Interestingly, though, not all trees die after getting struck by lightning—in fact, some kinda like it.
Yahoo
44 minutes ago
- Yahoo
Spiders may have evolved in the ocean before adapting to land, fossil reveals
One of the creepiest, crawliest creatures of the Earth may have been swimming before adapting to live on land, new research suggests. Spiders and their arachnid relatives may have actually originated in the sea, according to analysis of an "exquisitely preserved" fossil that lived 500 million years ago. The findings were published Tuesday in the journal Current Biology. MORE: 99-million-year-old 'zombie' fungi found preserved in amber, scientists say Researchers at the University of Arizona completed a detailed analysis of the brain and central nervous system of an extinct animal called Mollisonia symmetrica, according to the study. The species was previously thought to represent an ancestral member of a specific group of arthropods called chelicerates that lived during the Cambrian period -- between 540 and 485 million years ago. Chelicerates were believed to be ancestors to modern-day horseshoe crabs. However, the scientists were surprised to discover that the neural arrangements in Mollisonia's fossilized brain are not organized like those in horseshoe crabs. Instead, they are organized the same way as in modern spiders and their relatives, the researchers said. The anterior part of Mollisonia's body -- the prosoma -- contains a radiating pattern of segmental ganglia that control the movements of five pairs of segmental appendages, the researchers said. In addition, an unsegmented brain extends short nerves to a pair of pincer-like "claws," similar to the fangs of spiders and other arachnids. The decisive feature that demonstrates the fossil was likely an early arachnid is the unique organization of the brain -- a reverse of the front-to-back arrangement found in present-day crustaceans, insects, centipedes and horseshoe crabs, the researchers said. MORE: Fossils from giant possum-like mammal that lived 60 million years ago found in Texas It's as if the brain has been "flipped backwards," which is what is seen in modern spiders," said Nick Strausfeld, a regents professor at the University of Arizona and lead author of the paper, in a statement. This may be a crucial evolutionary development, as studies of existing spider brains suggest that a back-to-front arrangement in the brain provides shortcuts from neuronal control centers to underlying circuits, which control the spider's movements, said Frank Hirth, a reader of evolutionary neuroscience at King's College London and co-author of the paper. The arrangement likely helps the spiders hunt stealthily and dexterity for the spinning of webs. The arachnid brain is "unlike any other brain" on Earth, Strausfeld said. "This is a major step in evolution, which appears to be exclusive to arachnids," Hirth said. MORE: Fossils found in North America reveal new species of 'very odd' sea monster: Scientists Spiders and scorpions have existed for about 400 million years with little change -- dominating the Earth as the most successful group of arthropodan predators. The finding challenges the widely held belief that diversification occurred only after a common ancestor had moved to the shore, according to the study. Previous fossil records appeared to indicate that arachnids lived and diversified exclusively on land. "It is still vigorously debated where and when arachnids first appeared, and what kind of chelicerates were their ancestors, and whether these were marine or semi-aquatic like horseshoe crabs," Strausfeld said. While the Mollisonia outwardly resembles some other early chelicerates from the time period, its body was composed of two parts: a rounded "carapace" in the front and a sturdy segmented trunk ending in a tail-like structure, the analysis found. Some researchers had previously compared its body composition to that of scorpions, but no one had previously claimed that it was anything "more exotic" than a chelicerate. The first creatures to come onto land were likely millipede-like anthropods and other ancestral, insect-like creatures -- an evolutionary branch of crustaceans, Strausfeld said. MORE: What paleontologists learned from fossils of a 3-eyed predator that lived 500 million years ago Early insects and millipedes were likely part of the Mollisonia-like arachnid's daily diet when they adapted to land, he added. The first arachnids on land may have also contributed to the evolution of insect wings, a "critical defense mechanism," Strausfeld said. The Mollisonia's lineage likely gave rise to spiders, scorpions, sun spiders, vinegarroons and whip scorpions, the researchers said.
Yahoo
44 minutes ago
- Yahoo
Warmer summers ‘could boost growth rates in European peatlands'
Warmer summers could help boost growth rates in European peatlands, new research has found. The peatlands, which contain around half of Europe's soil carbon, need a combination of warm temperatures and a water table of around 10cm to thrive, researchers at Queen's University Belfast found. Peatlands form where there is a sustained build-up of partially decomposed plant matter, and they play a very important role in locking away greenhouse gases and absorbing industrial pollution. They contain approximately five times more carbon than its forests. However, European peatlands have been damaged by human activities including pollution, draining and climate change. Professor Graeme Swindles from the School of Natural and Built Environment at Queen's University has been leading a team examining peat accumulation rates, studying cores from 28 peat bogs across Europe. The study, which has now been published in research journal PLOS One, reveals that the fastest peat accumulation – nearly 0.5cm per year – occurred around the Baltic Sea, at sites in Denmark, Poland, Sweden, and Finland which experience warm and humid summers. The slowest peat accumulation was measured in northern Sweden, which experiences cold winters and a short growing season. Across all sites, peat was found to have accumulated fastest in regions with warm summer temperatures, which improves plant growth, and a water table around 10cm below the surface. Professor Swindles said the study suggests that warmer summer temperatures could boost growth rates in European peatlands – but only if the water table stays high enough. 'We also found that maintaining a water table around 10cm below the surface is key to allowing peat to grow quickly and store carbon over the long term,' he said. 'These findings strengthen current evidence and have important implications for how we restore and rewet peatlands as part of global efforts to tackle climate change.' Professor Swindles has also suggested that previous peatland restoration programs should be evaluated to determine if their relative successes or deficiencies corroborate these findings.
