Treatment of extensively drug-resistant tuberculosis in Tomsk, Russia: a retrospective cohort study.
BACKGROUND
Mycobacterium tuberculosis strains that cause untreatable drug-resistant disease are a threat worldwide. We describe the treatment, management, and outcomes of patients with extensively drug-resistant tuberculosis in Tomsk, Russia.


METHODS
We undertook a retrospective cohort study of 608 patients with multidrug resistant tuberculosis who had treatment in civilian or prison services, between Sept 10, 2000, and Nov 1, 2004, according to the treatment strategy recommended by WHO. Clinical characteristics, management practices, and treatment outcomes of patients with extensively drug-resistant (XDR) tuberculosis and non-extensively drug-resistant (non-XDR) tuberculosis are described. The main outcome was the frequency of poor and favourable outcomes at the end of treatment.


RESULTS
Of 608 patients with multidrug resistant tuberculosis, 29 (4.8%) patients had baseline XDR tuberculosis. Treatment failure was more common in patients with XDR tuberculosis than in those with non-XDR tuberculosis (31%vs 8.5%, p=0.0008). 48.3% of patients with XDR tuberculosis and 66.7% of patients with non-XDR tuberculosis had treatment cure or completion (p=0.04). The frequency and management of adverse events did not differ between patients with XDR and non-XDR tuberculosis.


CONCLUSIONS
The chronic features of tuberculosis in these patients suggest that extensively drug-resistant tuberculosis may be acquired through previous treatments that include second-line drugs. Aggressive management of this infectious disease is feasible and can prevent high mortality rates and further transmission of drug-resistant strains of Mycobacterium tuberculosis.
Keshavjee
Salmaan
S
Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
Gelmanova
Irina Y
IY
Farmer
Paul E
PE
Mishustin
Sergey P
SP
Strelis
Aivar K
AK
Andreev
Yevgeny G
YG
Pasechnikov
Alexander D
AD
Atwood
Sidney
S
Mukherjee
Joia S
JS
Rich
Michael L
ML
Furin
Jennifer J
JJ
Nardell
Edward A
EA
Kim
Jim Y
JY
Shin
Sonya S
SS
D000328:Adult; D000995:Antitubercular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D054908:Extensively Drug-Resistant Tuberculosis / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012424:Rural Population; D012426:Russia; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy*
D000995:Antitubercular Agents