[Multidrug-resistant tuberculosis management in three French hospitals].
BACKGROUND
Multidrug-resistant tuberculosis (MDR-TB) management is based on specific WHO guidelines.


OBJECTIVE
The authors report MDR-TB management, in three French hospitals.


METHODS
The authors retrospectively included patients with positive sample for multidrug-resistant Mycobacterium tuberculosis (isoniazid+rifampicin) from January 1, 2000 to December 31, 2005. The management was compared to the French and international prevalent guidelines.


RESULTS
Sixteen patients were initially managed for MDR-TB by eight different medical teams over 6 successive years: 12 (75%) presented with primary MDR-TB. Management advice from the national referee center (NRC) for tuberculosis was reported in seven out of 14 treated cases. The median length of the intensive treatment was 2 months (IQR: 1-3). Eight patients (58%) had an overall treatment length of 18 months. The median number of effective drugs prescribed was 4 (IQR: 4-5). Nine patients (64%) were also managed in a sanatorium. Only eight patients (57%) completed the prescribed treatment. Nine patients were clinically cured and still followed-up, six of whom were bacteriologically cured.


CONCLUSIONS
TB-MDR management was not conform to WHO guidelines in our study. Management in a sanatorium, NRC involvement, ambulatory DOT were highly beneficial.
Greffe
S
S
Service des maladies infectieuses, hôpital Avicenne, 125 route de Stalingrad, Bobigny, France. segolene.greffe@free.fr
Gros
I
I
Cruaud
P
P
Hornstein
M
M
Fain
O
O
Poirier
C
C
Abgrall
S
S
D000293:Adolescent; D000328:Adult; D000349:Africa / Q000208:ethnology; D000995:Antitubercular Agents / Q000627:therapeutic use*; D001208:Asia / Q000208:ethnology; D019468:Disease Management; D004359:Drug Therapy, Combination; D005260:Female; D005602:France / Q000453:epidemiology; D006763:Hospitals, Chronic Disease / Q000706:statistics & numerical data; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy*; D055815:Young Adult
D000995:Antitubercular Agents