Retreatment tuberculosis cases. Factors associated with drug resistance and adverse outcomes.
OBJECTIVE
Risk factors associated with treatment failure and multidrug-resistant tuberculosis (MDR-TB) were examined among HIV-seronegative patients who were previously treated for tuberculosis (TB).


METHODS
Prospective, cohort study of patients referred to the study hospital for retreatment of TB between March 1986 and March 1990.


METHODS
The patients belonged to three groups, according to outcomes following their previous treatment: 37 patients who abandoned treatment or suffered relapse after completion of therapy (group A), 91 patients who failed to respond to the first-line drug regimen (group B), and 78 patients who failed to respond to the second-line drug regimen (group C).


RESULTS
Patients with Mycobacterium tuberculosis strains resistant to rifampin and isoniazid were found in 2 (6%) in group A, 29 (33%) in group B, and 49 (65%) in group C. Cure was achieved in 77% in group A, 54% in group B, and 36% in group C. Death occurred in none of the patients in group A, 8% in group B, and 24% in group C. In a multivariate logistic regression analysis, unfavorable response (failure to sterilize sputum culture, death, and abandonment) was significantly associated with infection with a multidrug-resistant M tuberculosis strain (p = 0.0002), cavitary disease (p = 0.0029), or irregular use of medications (p < 0.0001).


CONCLUSIONS
These observations show that a previous treatment outcome and current clinical and epidemiologic histories can be used to predict the development of MDR-TB and adverse outcomes in patients undergoing retreatment for TB. Such information may be useful for identifying appropriate patient candidates for programs such as directly observed therapy.
Kritski
A L
AL
Servico de Pneumologia, Hospital Clementino Fraga Filho, da Universidade Federal do Rio de Janeiro, Brazil.
Rodrigues de Jesus
L S
LS
Andrade
M K
MK
Werneck-Barroso
E
E
Vieira
M A
MA
Haffner
A
A
Riley
L W
LW
D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002423:Cause of Death; D002985:Clinical Protocols; D015331:Cohort Studies; D005260:Female; D005544:Forecasting; D018023:HIV Seronegativity; D006801:Humans; D007538:Isoniazid / Q000627:therapeutic use; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009169:Mycobacterium tuberculosis / Q000187:drug effects; D010349:Patient Compliance; D011446:Prospective Studies; D012008:Recurrence; D012074:Remission Induction; D019233:Retreatment; D012293:Rifampin / Q000627:therapeutic use; D012307:Risk Factors; D013183:Sputum / Q000382:microbiology; D016896:Treatment Outcome; D016312:Treatment Refusal; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy*; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy*
D000995:Antitubercular Agents; D007538:Isoniazid; D012293:Rifampin