Predictors of poor outcomes among patients treated for multidrug-resistant tuberculosis at DOTS-plus projects - 24/08/12
, Allison Taylor a, Victoria M. Gammino a, Jaime Bayona b, c, Mercedes Becerra b, c, Manfred Danilovitz d, Dennis Falzon e, Irina Gelmanova b, Salmaan Keshavjee b, c, Vaira Leimane f, Carole D. Mitnick b, c, Ma. Imelda Quelapio g, Vija Riekstina f, Piret Viiklepp h, Matteo Zignol e, J. Peter Cegielski a
Corresponding author. International Research and Programs Branch, Division of Tuberculosis Elimination, CDC, Mailstop E-10, 1600 Clifton Road, NE, Atlanta, GA 30333, USA. Tel.: +1 404 639 2017; fax: +1 404 639 1566.Summary |
The Objective of this analysis was to identify predictors of death, failure, and default among MDR-TB patients treated with second-line drugs in DOTS-plus projects in Estonia, Latvia, Philippines, Russia, and Peru, 2000–2004.
Risk ratios (RR) with 95% confidence intervals (CI) were calculated using multivariable regression.
Of 1768 patients, treatment outcomes were: cure/completed – 1156 (65%), died – 200 (11%), default - 241 (14%), failure - 118 (7%). Independent predictors of death included: age>45 years (RR = 1.90 (95%CI 1.29–2.80), HIV infection (RR = 4.22 (2.65–6.72)), extrapulmonary disease (RR = 1.54 (1.04–2.26)), BMI<18.5 (RR = 2.71 (1.91–3.85)), previous use of fluoroquinolones (RR = 1.91 (1.31–2.78)), resistance to any thioamide (RR = 1.59 (1.14–2.22)), baseline positive smear (RR = 2.22 (1.60–3.10)), no culture conversion by 3rd month of treatment (RR = 1.69 (1.19–2.41)); failure: cavitary disease (RR = 1.73 (1.07–2.80)), resistance to any fluoroquinolone (RR = 2.73 (1.71–4.37)) and any thioamide (RR = 1.62 (1.12–2.34)), and no culture conversion by 3rd month (RR = 5.84 (3.02–11.27)); default: unemployment (RR = 1.50 (1.12–2.01)), homelessness (RR = 1.52 (1.00–2.31)), imprisonment (RR = 1.86 (1.42–2.45)), alcohol abuse (RR = 1.60 (1.18–2.16)), and baseline positive smear (RR = 1.35 (1.07–1.71)).
Patients with biomedical risk factors for treatment failure or death should receive heightened medical attention. To prevent treatment default, management of patients who are unemployed, homeless, alcoholic, or have a prison history requires extra measures to insure treatment completion.
Le texte complet de cet article est disponible en PDF.Keywords : Multidrug-resistant tuberculosis, Treatment outcomes, Risk factors
Plan
Vol 92 - N° 5
P. 397-403 - septembre 2012 Retour au numéro
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