{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T06:21:24Z","timestamp":1782973284863,"version":"3.54.5"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2021,9,1]],"date-time":"2021-09-01T00:00:00Z","timestamp":1630454400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":["www.atsjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,9,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>Until 2020, extensively drug-resistant tuberculosis (XDR-TB) was defined as TB with resistance to rifampicin and isoniazid (multidrug-resistant TB [MDR-TB]), any fluoroquinolone (FQ), and any second-line injectable drug (SLID). In 2019, the World Health Organization issued new recommendations for treating patients with drug-resistant TB, substantially limiting the role of SLIDs in MDR-TB treatment and thus putting the definition of XDR-TB into question.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To propose an up-to-date definition for XDR-TB.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We used a large data set to assess treatment outcomes for patients with MDR-TB exposed to any type of longer regimen. We included patients with bacteriologically confirmed MDR-TB and known FQ and SLID resistance results. We performed logistic regression to estimate the adjusted odds ratios (aORs) for an unfavorable treatment outcome (failure, relapse, death, loss to follow-up), and estimates were stratified by the resistance pattern (FQ and\/or SLID) and group A drug use (moxifloxacin\/levofloxacin, linezolid, and\/or bedaquiline).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results<\/jats:title>\n                    <jats:p>We included 11,666 patients with MDR-TB; 4,653 (39.9%) had an unfavorable treatment outcome. Resistance to FQs increased the odds of an unfavorable treatment outcome (aOR, 1.91; 95% confidence interval [CI], 1.63\u20132.23). Administration of bedaquiline and\/or linezolid improved treatment outcomes regardless of resistance to FQs and\/or SLIDs. Among patients with XDR-TB, compared with persons receiving no group A drug, aORs for an unfavorable outcome were 0.37 (95% CI, 0.20\u20130.69) with linezolid only, 0.40 (95% CI, 0.21\u20130.77) with bedaquiline only, and 0.21 (95% CI, 0.12\u20130.38) with both.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our study supports a new definition of XDR-TB as MDR-TB and additional resistance to FQ plus bedaquiline and\/or linezolid and helps assess the adequacy of this definition for surveillance and treatment choice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1164\/rccm.202009-3527oc","type":"journal-article","created":{"date-parts":[[2021,6,9]],"date-time":"2021-06-09T19:12:03Z","timestamp":1623265923000},"page":"713-722","update-policy":"https:\/\/doi.org\/10.1164\/crossmarkpolicies","source":"Crossref","is-referenced-by-count":33,"title":["Evidence-based Definition for Extensively Drug-Resistant Tuberculosis"],"prefix":"10.1093","volume":"204","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0876-4673","authenticated-orcid":false,"given":"Maroussia","family":"Roelens","sequence":"first","affiliation":[{"name":"Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Battista Migliori","sequence":"additional","affiliation":[{"name":"Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico, Tradate, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liudmila","family":"Rozanova","sequence":"additional","affiliation":[{"name":"Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janne","family":"Estill","sequence":"additional","affiliation":[{"name":"Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland"},{"name":"Institute of Mathematical Statistics and Actuarial Science, University of Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathon R.","family":"Campbell","sequence":"additional","affiliation":[{"name":"McGill International Tuberculosis Centre, McGill University, Montreal, Quebec, Canada"},{"name":"Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Peter","family":"Cegielski","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Tiberi","sequence":"additional","affiliation":[{"name":"Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom"},{"name":"Division of Infection, Royal London Hospital, Barts Health National Health Service Trust, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Domingo","family":"Palmero","sequence":"additional","affiliation":[{"name":"Hospital F. J. Mu\u00f1iz, Buenos Aires, Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Greg J.","family":"Fox","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo","family":"Guglielmetti","sequence":"additional","affiliation":[{"name":"\u00c9quipe 13, Centre d\u2019Immunologie et des Maladies Infectieuses, Sorbonne Universit\u00e9, Unit\u00e9 1135, Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale, Paris, France"},{"name":"Centre National de R\u00e9f\u00e9rence des Mycobact\u00e9ries et de la R\u00e9sistance des Mycobact\u00e9ries aux Antituberculeux, H\u00f4pital Piti\u00e9-Salp\u00eatri\u00e8re, Groupe Hospitalier Universitaire Sorbonne Universit\u00e9, Assistance Publique\u2013H\u00f4pitaux de Paris, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Sotgiu","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James C. 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