Treatment Practices, Outcomes, and Costs of Multidrug-Resistant and Extensively Drug-Resistant Tuberculosis, United States, 2005–2007

Abstract

Drug resistance was extensive and care was complex; nevertheless, high rates of treatment completion were achieved albeit at considerable cost.

The California Multidrug-Resistant Tuberculosis Consult Service: a partnership of state and local programs

“…Few patients (n = 7, 5%) moved before treatment completion, and mortality was low, at 4%, compared to 9% reported among US MDR-TB patients. 20,21 Mortality was also lower in this cohort than that reported among California MDR-TB patients from 1994 to 2002 (14%), and also lower than among California non-MDR-TB cases in 2014 (7.4%). 7,19,20,22,23 Our cohort of MDR-TB patients had a median age of 26 years; only one patient was living with HIV.…”

“…20,21 Mortality was also lower in this cohort than that reported among California MDR-TB patients from 1994 to 2002 (14%), and also lower than among California non-MDR-TB cases in 2014 (7.4%). 7,19,20,22,23 Our cohort of MDR-TB patients had a median age of 26 years; only one patient was living with HIV. These demographic characteristics are different from data reported on California patients with MDR-TB from 1994 to 2002 (median age 42 years, 4% living with HIV), suggesting a potential change in the characteristics of California MDR-TB patients.…”

“…19,20 These successful outcomes were achieved among patients who had isolates with substantial resistance (42% with resistance beyond INH and RMP). Few patients (n = 7, 5%) moved before treatment completion, and mortality was low, at 4%, compared to 9% reported among US MDR-TB patients.…”

“…Given the toxicity of the medications and the reported frequency of side effects, we expected some patients to discontinue treatment before the indicator targets were met. 20,24,25 Of the nine cases who did not undergo rapid molecular DST, eight were born in countries with high rates of resistance, which should have prompted the request for rapid molecular DST. The Service should continue to educate and encourage the use of rapid molecular DST to ensure prompt treatment with drugs to which the patients are presumed to be susceptible.…”

Predictors of Outcome in Drug Resistant Tuberculosis Patients

“…A patient who has completed treatment and has been consistently culture negative (5 consecutive negative results in the last 12 to 15 months) [12].…”