Management of tuberculosis in the European Union: a multicentre audit

Introduction: In 2010, a clinical audit on tuberculosis (TB) management in the European Union and European Economic Area (EU/EEA) identified important gaps between international standards of care and the management of TB patients, particularly for those with multidrug- or extensively drug resistant tuberculosis (MDR/XDR-TB). The results informed the development of the European Union Standards for TB Care (ESTC). Objective: We conducted a new audit aiming at assessing if TB management, including infection control measures, in EU/EEA clinical care centres was consistent with the ESTC. Methods: TB reference hospitals in five EU/EEA countries were purposely selected. In each hospital a maximum of 40 medical records of consecutive confirmed TB cases, diagnosed between 2012 and 2014, were reviewed. Ethical approval was obtained if required by the local legislation. Results: Data from 122 patients with XDR-TB (n= 11), pre-XDR-TB (n= 29) MDR-TB (n= 49), and drug-susceptible TB (n= 33) showed that TB diagnosis and treatment were according to the ESTC. Treatment outcomes were duly registered and hospitals reached the target for treatment success (75-100%) for patients with drug-resistant TB. All TB patients were offered, and subsequently accepted, HIV testing and counselling. However, antiretroviral treatment was not immediately offered to all TB patients co-infected with HIV. Infection control procedures were properly implemented. Therapeutic drug monitoring and routine genetic typing of TB strains, although not considered a standard in the ESTC, were used in some EU/EEA settings. Conclusions: Overall, selected EU/EEA reference centres reported good adherence to the ESTC.