Predictors of poor outcomes among patients treated for multidrug-resistant tuberculosis at DOTS-plus projects

Details

• Alternative Title:
  Tuberculosis (Edinb)
• Personal Author:
  Kurbatova, Ekaterina V ; Taylor, Allison ; Gammino, Victoria M ; Bayona, Jaime ; Becerra, Mercedes ; Danilovitz, Manfred ; Falzon, Dennis ; Gelmanova, Irina ; Keshavjee, Salmaan ; Leimane, Vaira ; Mitnick, Carole D ; Quelapio, Ma. Imelda ; Riekstina, Vija ; Viiklepp, Piret ; Zignol, Matteo ; Cegielski, J Peter
• Description:
  BACKGROUND
  
  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.
  
  METHODS
  
  Risk ratios (RR) with 95% confidence intervals (CI) were calculated using multivariable regression.
  
  RESULTS
  
  Of 1,768 patients, treatment outcomes were: cure/completed – 1,156 (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)).
  
  CONCLUSION
  
  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.
  
  
• Keywords:
  Adult Age Factors Antitubercular Agents Body Mass Index Directly Observed Therapy Estonia Female HIV Seropositivity Humans Latvia Male Multidrug-resistant Tuberculosis Odds Ratio Outcome Assessment, Health Care Peru Philippines Predictive Value Of Tests Retrospective Studies Risk Factors Russia Socioeconomic Factors Substance-Related Disorders Treatment Outcomes Tuberculosis, Multidrug-Resistant

  More +
• Source:
  Tuberculosis (Edinb). 92(5):397-403
• Pubmed ID:
  22789497
• Pubmed Central ID:
  PMC4749016
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/
• Volume:
  92
• Issue:
  5
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:083de0ac6bf71f3e18646a4ab2bc71e142a7a32658fbab39c108c1c77e80e4e7
• Download URL:
  https://stacks.cdc.gov/view/cdc/37959/cdc_37959_DS1.pdf
• File Type:
  [PDF - 302.52 KB ]