title: Treatment and follow-up of HIV-negative multidrug-resistant tuberculosis patients in an infectious diseases reference hospital, Buenos Aires, Argentina.
abstract: METHODS
  An Argentinean reference hospital specialising in infectious diseases.
  
  
  OBJECTIVE
  To assess the outcomes of all human immunodeficiency virus (HIV) negative multidrug-resistant tuberculosis (MDR-TB) patients referred to or diagnosed at Hospital Muñiz.
  
  
  METHODS
  Clinical study for the period 1996-1999, with follow-up until June 2002.
  
  
  RESULTS
  One hundred and forty-one adult patients (52.5% female) with resistance to two to seven drugs were studied. Fifty patients (35.5%) had not been treated previously. The most frequently used second-line drugs were 5-F-quinolones, cycloserine and ethionamide in susceptibility based individually tailored three- to five-drug regimens. Hospital admission was associated with treatment success. Forty-five episodes of severe toxicity occurred. Treatment was successful in 51.8% of cases, but follow-up of 73 patients yielded 11.9% relapse. The mortality rate was 19.1% and default was 19.9%. Logistic regression analysis was statistically significant for treatment success in relation to patient admission, residence and resistance pattern.
  
  
  CONCLUSIONS
  The burden of MDR-TB in this setting--prolonged infection, treatment cost and difficulties, low rates of cure and treatment adherence and high rates of fatality and relapse--can be improved by strengthening TB control programme activities and fighting against poverty and HIV/AIDS.
authors.affiliation: Department of Pneumonology, Hospital Muñiz, Buenos Aires, Argentina. djpalmero@intramed.net.ar
authors.forename: D J
authors.initials: DJ
authors.lastname: Palmero
authors.forename: M
authors.initials: M
authors.lastname: Ambroggi
authors.forename: A
authors.initials: A
authors.lastname: Brea
authors.forename: M
authors.initials: M
authors.lastname: De Lucas
authors.forename: A
authors.initials: A
authors.lastname: Fulgenzi
authors.forename: D
authors.initials: D
authors.lastname: Martínez
authors.forename: C
authors.initials: C
authors.lastname: Mosca
authors.forename: R
authors.initials: R
authors.lastname: Musella
authors.forename: M
authors.initials: M
authors.lastname: Natiello
authors.forename: C
authors.initials: C
authors.lastname: Gonzalez
authors.forename: E
authors.initials: E
authors.lastname: Abbate
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000150:complications; D000995:Antitubercular Agents / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D001118:Argentina / Q000453:epidemiology; D003523:Cycloserine / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D004338:Drug Combinations; D005000:Ethionamide / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D018023:HIV Seronegativity; D006760:Hospitalization; D006782:Hospitals, Special; D006801:Humans; D016015:Logistic Models; D008297:Male; D008826:Microbial Sensitivity Tests; D009169:Mycobacterium tuberculosis / Q000187:drug effects* / Q000302:isolation & purification; D011379:Prognosis; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*
chemical_list: D000995:Antitubercular Agents; D004338:Drug Combinations; D003523:Cycloserine; D005000:Ethionamide