Treatment outcomes of multidrug-resistant tuberculosis: a systematic review and meta-analysis.
BACKGROUND
Treatment outcomes for multidrug-resistant Mycobacterium Tuberculosis (MDRTB) are generally poor compared to drug sensitive disease. We sought to estimate treatment outcomes and identify risk factors associated with poor outcomes in patients with MDRTB.


RESULTS
We performed a systematic search (to December 2008) to identify trials describing outcomes of patients treated for MDRTB. We pooled appropriate data to estimate WHO-defined outcomes at the end of treatment and follow-up. Where appropriate, pooled covariates were analyzed to identify factors associated with worse outcomes. Among articles identified, 36 met our inclusion criteria, representing 31 treatment programmes from 21 countries. In a pooled analysis, 62% [95% CI 57-67] of patients had successful outcomes, while 13% [9]-[17] defaulted, 11% [9]-[13] died, and 2% [1]-[4] were transferred out. Factors associated with worse outcome included male gender 0.61 (OR for successful outcome) [0.46-0.82], alcohol abuse 0.49 [0.39-0.63], low BMI 0.41[0.23-0.72], smear positivity at diagnosis 0.53 [0.31-0.91], fluoroquinolone resistance 0.45 [0.22-0.91] and the presence of an XDR resistance pattern 0.57 [0.41-0.80]. Factors associated with successful outcome were surgical intervention 1.91 [1.44-2.53], no previous treatment 1.42 [1.05-1.94], and fluoroquinolone use 2.20 [1.19-4.09].


CONCLUSIONS
We have identified several factors associated with poor outcomes where interventions may be targeted. In addition, we have identified high rates of default, which likely contributes to the development and spread of MDRTB.
Johnston
James C
JC
Tuberculosis Control, British Columbia Centre for Disease Control, Vancouver, Canada. johnst22@interchange.ubc.ca
Shahidi
Neal C
NC
Sadatsafavi
Mohsen
M
Fitzgerald
J Mark
JM
D000368:Aged; D000369:Aged, 80 and over; D000437:Alcoholism / Q000150:complications; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D015992:Body Mass Index; D002986:Clinical Trials as Topic; D024881:Drug Resistance, Bacterial; D005260:Female; D024841:Fluoroquinolones / Q000494:pharmacology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012107:Research Design; D012307:Risk Factors; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000150:complications / Q000188:drug therapy*
D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones