Pulmonary resection in the treatment of patients with pulmonary multidrug-resistant tuberculosis in Taiwan.
METHODS
Chronic Disease Control Bureau, Department of Health, Taiwan.


OBJECTIVE
To evaluate the role of pulmonary resection in the treatment of pulmonary tuberculosis resistant to isoniazid and rifampin (MDR-TB).


METHODS
In a retrospective cohort study, 27 MDR-TB patients who underwent pulmonary resection between December 1990 and March 1999 were reviewed. Individually-tailored treatment regimens were selected at a once-weekly staff conference following review of the patient's case history and drug susceptibility results. Surgery was performed for selected patients, essentially those: 1) whose medical treatment had failed, or for whom treatment failure seemed highly likely, or for whom post-treatment relapse seemed likely, 2) with predominantly localised disease, 3) with adequate cardiopulmonary reserve, and 4) whose treatment regimen had been composed of at least two effective drugs to diminish the mycobacterial burden.


RESULTS
There was no surgical mortality apart from one peri-operative death (4%). Three patients (11%) developed complications, and 24 (92%) patients demonstrated sputum conversion and/or remained negative after surgery. Twenty-three patients have already completed treatment, and during a mean of 42 +/- 18 follow-up months (range 15-80 months), one patient relapsed. This patient was disease-free after another course of treatment.


CONCLUSIONS
For selected patients, pulmonary resection may improve the outcome of pulmonary MDR-TB.
Chiang
C Y
CY
Chronic Disease Control Bureau, Department of Health, Shen-Keng Shiang, Taipei County, Taipei, Taiwan, Republic of China.
Yu
M C
MC
Bai
K J
KJ
Suo
J
J
Lin
T P
TP
Lee
Y C
YC
D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011013:Pneumonectomy; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery*; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery*
D000995:Antitubercular Agents