Treatment outcomes of patients with multidrug-resistant and extensively drug resistant tuberculosis in Hunan Province, China

Abstract

BackgroundThe worldwide emergence of multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) has posed additional challenges for global tuberculosis (TB) control efforts, as limited treatment options are available and treatment outcomes are often sub-optimal. This study determined treatment outcomes among a cohort of MDR-TB and XDR-TB patients in Hunan Province, China, and identified factors associated with poor treatment outcomes.MethodsWe conducted a retrospective study using data obtained from medical records of TB patients in Hunan Chest Hospital, and from the internet-based TB management information system managed by the Tuberculosis Control Institute of Hunan Province, for the period 2011 to 2014. Treatment outcomes were assessed for patients diagnosed with MDR-TB (TB resistant to at least isoniazid and rifampicin) and XDR-TB (MDR-TB plus resistance to any fluoroquinolone and at least 1 second-line injectable drug). Cumulative incidence functions were used to estimate time to events (i.e. poor treatment outcomes, loss to follow-up, and unfavourable treatment outcomes); and a competing-risks survival regression model was used to identify predictors of treatment outcomes.ResultOf 481 bacteriologically-confirmed patients, with a mean age of 40 years (standard deviation SD ± 13 years), 10 (2%) had XDR-TB and the remainder (471; 98%) had MDR-TB. For the entire cohort, treatment success was 57% (n = 275); 58% (n = 272) for MDR-TB and 30% (n = 3) for XDR-TB. Overall, 27% were lost to follow-up (n = 130), 27% (n = 126) for MDR-TB and 40% (n = 4) for XDR-TB; and 16% had a poor treatment outcome (n = 76), 15% for MDR-TB and 30% (n = 3) for XDR-TB. Of the 10 XDR-TB patients, 3 (30%) completed treatment, 3 (30%) died and 4 (40%) were lost to follow-up. Of the 471 MDR-TB patients, 258 (57%) were cured, 16 (3%) completed treatment, 13 (3%) died, 60 (13%) experienced treatment failure, and 126 (27%) were lost to follow-up. Resistance to ofloxacin was an independent predictor of poor (AHR = 3.1; 95%CI = 1.5, 6.3), and unfavourable (AHR = 1.7; 95%CI = 1.07, 2.9) treatment outcomes. Patients who started treatment during 2011–2012 (AHR = 2.8; 95% CI = 1.5, 5.3) and 2013 (AHR = 2.1; 95% CI = 1.2, 3.9) had poorer treatment outcomes compared to patients who started treatment during 2014.ConclusionPatients with MDR-TB and XDR-TB had low rates of treatment success in Hunan Province, especially among patients who started treatment during 2011 to 2013, with evidence of improved treatment outcomes in 2014. Resistance to ofloxacin was an independent predictor of poor treatment outcomes.

Loss to Follow-Up (LTFU) during Tuberculosis Treatment

“…They defined LTFU as "A TB patient who did not start treatment or whose treatment was interrupted for 2 consecutive months or more." Since then, several papers have started reporting according to this new term and definition [3][4][5][6][7][8][9][10].…”

Risk factors for multidrug‐resistant tuberculosis in northwest Ethiopia: A case–control study

“…The emergence of MDR‐TB has become a major public health problem in a number of countries and an obstacle to global TB control efforts (WHO, ). Treatment for MDR‐TB is more lengthy, toxic and expensive when compared to drug‐susceptible TB, and cure rates are often lower at 52%–75% (Alene, Viney, McBryde, Tsegaye, & Clements, ; Alene, Yi, et al, ; WHO, ).…”

Multidrug Resistant Tuberculosis in Children in Port Harcourt – A Worrisome Trend

“…While outcome to MDR-TB is poor ranging from 48-61% in some studies [25][26][27], our patients have shown a very good outcome so far as 75% of them have completed 4-6months of intensive phase and are at different stages of the continuation phase, while one (25%) is in the intensive phase and is still on admission. One of the patients however had a change of medications as he developed hepatotoxicity with rising hepatic enzymes.…”