Tuberculosis Mortality In The United States: How Can It Be Prevented?

Beavers, Suzanne F.; Flood, Jennifer; Weinfurter, Paul; Davidow, Amy L.; Hirsch‐Moverman, Yael; Thickstun, P M; Munguia, Guadalupe; Kundupati, Saini; Mangan, Joan M.; Stein-Hart, Trudy; Belknap, Robert; Graviss, Edward A.

doi:10.1164/ajrccm-conference.2012.185.1_meetingabstracts.a6062

Cited by 5 publications

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“…The proportion of patients for whom TB disease was a cause of death was unknown. However, California participated in a national study that demonstrated that 72% of deaths among TB patients reported to the national surveillance system in 2005–2006 were TB related [ 26 ]. Thus, TB likely contributed to the vast majority of deaths in our study.…”

Section: Discussionmentioning

confidence: 99%

Death With Tuberculosis in California, 1994–2008

Pascopella

Barry

Flood

et al. 2014

Open Forum Infectious Diseases

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Background Identifying factors associated with tuberculosis (TB) deaths will inform efforts to prevent deaths.Methods We examined deaths among patients with culture-confirmed TB reported to the California TB Registry during 1994–2008. We calculated the age-adjusted percentage of deaths before and during TB treatment and estimated trends. We constructed multivariable logistic regression models to identify factors associated with death during treatment.Results Of 40 125 patients with culture-confirmed TB, 4565 (11%) died: 1146 (25%) died before treatment started, and 3419 (75%) died during treatment. The age-adjusted percentage of patients who died before and during treatment declined from 1994 to 2008 (3.5% to 2%, and 10.4% to 7.2%, respectively, both P < .0001). We identified several risk factors for death that may be addressed with public health efforts: acquired multidrug resistance (adjusted odds ratio [aOR] = 4.67; 95% confidence interval [CI], 2.09–10.45); care in the private sector (aOR = 3.08; 95% CI, 2.75–3.44); and an initial treatment regimen of <3 drugs (aOR = 2.07; 95% CI, 1.63–2.64). We identified other risk factors for death that could be used as markers for intensified diagnostic and treatment processes in hospital: human immunodeficiency virus coinfection; meningeal, peritoneal, and disseminated TB; substance use; and abnormal chest radiograph without cavities.Conclusions In California, 1 in 9 TB patients died with a potentially curable disease. Public health departments might prevent deaths in patients with TB by strengthening partnerships with private providers, intensifying diagnostic and treatment processes for patients at risk of death in hospital, optimizing treatment regimens for patients with comorbidities, and preventing the acquisition of drug resistance.

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Section: Discussionmentioning

confidence: 99%

Death With Tuberculosis in California, 1994–2008

Pascopella

Barry

Flood

et al. 2014

Open Forum Infectious Diseases

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“…The severity of TB disease was stratified into 3 categories used in another study: extensive, moderate, and minimal [ 29 ]. Extensive disease was defined as having a miliary pattern on imaging study, or pathology indicating extensive pulmonary TB disease, or massive tubercular empyema or pleural effusion that opacified the entire hemithorax, or ≥2 of the following: sputum smear-positive disease, failure to convert sputum culture within 60 days, cavitary disease on imaging, bilateral disease or multilobar disease, or collapse of 1 or more lobes.…”

Section: Methodsmentioning

confidence: 99%

Clinical Impact on Tuberculosis Treatment Outcomes of Discordance Between Molecular and Growth-Based Assays for Rifampin Resistance, California 2003–2013

Shah

Lin

Barry

et al. 2016

Open Forum Infectious Diseases

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Background. Data from international settings suggest that isolates of Mycobacterium tuberculosis with rpoB mutations testing phenotypically susceptible to rifampin (RIF) may have clinical significance. We analyzed treatment outcomes of California patients with discordant molecular-phenotypic RIF results.Methods. We included tuberculosis (TB) patients, during 2003–2013, whose specimens tested RIF susceptible phenotypically but had a rpoB mutation determined by pyrosequencing. Demographic data were abstracted from the California TB registry. Phenotypic drug-susceptibility testing, medical history, treatment, and outcomes were abstracted from medical records.Results. Of 3330 isolates tested, 413 specimens had a rpoB mutation (12.4%). Of these, 16 (3.9%) had molecular-phenotypic discordant RIF results. Seven mutations were identified: 511Pro, 516Phe, 526Asn, 526Ser (AGC and TCC), 526Cys, and 533Pro. Fourteen (88%) had isoniazid (INH) resistance, 6 of whom were also phenotypically resistant to ethambutol (EMB) and/or pyrazinamide (PZA). Five patients (25%), 1 with 511Pro and 4 with 526Asn, relapsed or failed treatment. The initial regimen for 3 patients was RIF, PZA, and EMB; 1 patient received RIF, PZA, EMB, and a fluoroquinolone (FQN); and 1 patient received RIF, EMB, FQN, and some second-line medications. Upon retreatment with an expanded regimen, 3 (75%) patients completed treatment, 1 patient moved before treatment completion, and 1 patient continues on treatment. The remaining 11 patients had a successful outcome with 9 having received a FQN and/or a rifamycin.Conclusions. Rifampin molecular-phenotypic discordance was rare, and most isolates had INH resistance. Patients who did not receive an expanded regimen had poor outcomes. These mutations may have clinical importance, and expanded treatment regimens should be considered.

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“…T uberculosis (TB) is the leading cause of death among people living with human immunodeficiency virus (HIV). 1 The association between HIV and TB mortality has been studied extensively, [2][3][4][5][6][7][8] but the impact of HIV on other clinically relevant aspects of TB care such as TB related drug adverse events (AEs), [9][10][11] hospital readmissions, 12 and TB treatment duration is less characterized. To our knowledge no published study has examined all the above complexities in one cohort.…”

Section: Introductionmentioning

confidence: 99%

Treatment Complexities Among Patients with Tuberculosis in a High HIV Prevalence Cohort in the United States

Bizune

Kempker

Kagei

et al. 2018

AIDS Research and Human Retroviruses

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The association between human immunodeficiency virus (HIV) infection and tuberculosis (TB) mortality has been studied extensively, but the impact of HIV on other clinically relevant aspects of TB care such as TB drug-related adverse events (AEs), hospital readmissions, and TB treatment duration is less well characterized. We describe the association of HIV infection with TB clinical complexities and outcomes in a high HIV prevalence cohort in the United States. This is a retrospective cohort study among patients treated for culture-confirmed TB between 2008 and 2015 at an inner-city hospital in Atlanta, GA. Univariate analysis was used to estimate association of HIV with TB treatment interruption due to AEs, hospital readmissions, and treatment duration. Final unfavorable TB treatment outcome was defined as death, loss to follow-up, or recurrent TB. Logistic regression modeling was used to estimate association of HIV with final unfavorable outcomes. Among 274 patients with TB, 96 (35%) had HIV coinfection. HIV-positive patients had more TB treatment interruptions due to AE (34% vs. 15%), were more likely to have a hospital readmission (50% vs. 21%), and received longer TB treatment (9.9 months vs. 8.8 months) compared to HIV-negative patients (p < .01 for all). HIV infection was not associated with final unfavorable outcomes in univariate [odds ratio (OR) = 1.86; confidence interval (95% CI) 0.99-3.49] or multivariate analysis (aOR = 1.13; 95% CI 0.52-2.39) (p ≥ .05 for both). While HIV infection was not associated with final unfavorable TB outcomes, TB/HIV coinfected patients had more complex treatment course underscoring the importance of maintaining resources and expertise to treat coinfected patients in our and similar settings.

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Tuberculosis Mortality In The United States: How Can It Be Prevented?

Cited by 5 publications

References 0 publications

Death With Tuberculosis in California, 1994–2008

Death With Tuberculosis in California, 1994–2008

Clinical Impact on Tuberculosis Treatment Outcomes of Discordance Between Molecular and Growth-Based Assays for Rifampin Resistance, California 2003–2013

Treatment Complexities Among Patients with Tuberculosis in a High HIV Prevalence Cohort in the United States

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