title: [Factors related to the occurrence of multi- (extensively-) drug resistant tuberculosis (M/XDR-TB) in our hospital].
abstract: OBJECTIVE
  To analyze the clinical characteristics of multi- (extensively-) drug-resistant tuberculosis (M/XDR-TB) in our hospital.
  
  
  METHODS
  One-hundred and forty-one cases diagnosed with MDR-TB and thirteen cases with XDR-TB admitted to our hospital over the last nine years were enrolled in this study.
  
  
  RESULTS
  The gender distribution was: ninety-nine males and forty-two females in MDR-TB and nine males and four females in XDR-TB. The mean age was 52.0 years in males and 43.1 years in females in the MDR-TB patients, and 49.1 years in males and 42.0 years in females in the XDR-TB patients. There were 11 Chinese patients and 7 Koreans, as well as 8 patients from other countries abroad. Eighty-four (59.6%) MDR-TB patients and 9 (69.2%) XDR-TB patients had a smoking history. Diabetes mellitus was seen in 30 MDR-TB and 3 XDR-TB patients. The period from manifestation to the first visit to our hospital was 41.5 months on average in the MDR-TB patients, and 79.6 months in the XDR-TB patients. The average period from first diagnosis of TB to that of M/XDR-TB was 30.9 months in the MDR and 56.8 months in the XDR. Thirty (21.3%) MDR-TB patients and one (7.7%) XDR-TB patient were first diagnosed in our hospital. One-hundred and fifteen patients (81.6%) with MDR-TB and 6 (46.1%) with XDR-TB achieved negative sputum bacteriological conversion. Fifty-six cases (48.7%) of 115 MDR-TB and all (100%) of the XDR-TB patients underwent surgical treatment. Sixteen (11.3%) MDR-TB and 3 (23.1%) XDR-TB patients died. Thirty of the MDR-TB and 1 of the XDR-TB patients had never been previously treated for tuberculosis. Twelve (8.5%) MDR-TB and 5 (38.5%) XDR-TB patients had been treated with four drugs including isoniazid (INH), rifampicin (RFP), pyrazinamide (PZA), and either ethambutol (EB) or streptomycin (SM) in previous hospitals. Twenty-five (17.7%) MDR-TB and 5 (38.5%) XDR-TB patients had been treated with three drug regimens not including PZA in previous hospitals.
  
  
  CONCLUSIONS
  M/XDR-TB is a man-made disease and can be infectious. Even the current standard regimens can produce M/ XDR-TB, if they are used improperly and carelessly. Great care should be taken to prevent XDR and MDR-TB.
authors.affiliation: Department of Respiratory Medicine, Fukujuji Hospital, Japan Anti-Tuberculosis Association (JATA), Tokyo, Japan. okumuram@fukujuji.org
authors.forename: Masao
authors.initials: M
authors.lastname: Okumura
authors.forename: Takashi
authors.initials: T
authors.lastname: Yoshiyama
authors.forename: Hideo
authors.initials: H
authors.lastname: Ogata
authors.forename: Kozo
authors.initials: K
authors.lastname: Morimoto
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kokuto
authors.forename: Atsuyuki
authors.initials: A
authors.lastname: Kurashima
authors.forename: Shoji
authors.initials: S
authors.lastname: Kudoh
mesh_terms: D000367:Age Factors; D000995:Antitubercular Agents / Q000008:administration & dosage*; D023801:Directly Observed Therapy; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D005791:Patient Care; D010349:Patient Compliance; D012189:Retrospective Studies; D012737:Sex Factors; D013997:Time Factors; D018088:Tuberculosis, Multidrug-Resistant / Q000453:epidemiology* / Q000517:prevention & control* / Q000628:therapy
chemical_list: D000995:Antitubercular Agents