title: Adjunctive surgery improves treatment outcomes among patients with multidrug-resistant and extensively drug-resistant tuberculosis.
abstract: OBJECTIVE
  To determine risk factors for poor outcomes among patients with pulmonary multidrug- or extensively drug-resistant (M/XDR) tuberculosis (TB) in Georgia.
  
  
  METHODS
  This was a prospective, population-based observational cohort study.
  
  
  RESULTS
  Among 380M/XDR-TB patients (mean age 38 years), 179 (47%) had a poor outcome: 59 (16%) died, 37 (10%) failed, and 83 (22%) defaulted. Newly diagnosed M/XDR-TB cases were significantly more likely to have a favorable outcome than retreatment cases (odds ratio (OR) 4.26, 95% confidence interval (CI) 1.99-9.10, p<0.001). In the multivariable analysis, independent risk factors for a poor treatment outcome included previous treatment history (OR 2.92, 95% CI 1.29-6.58), bilateral disease (OR 1.90, 95% CI 1.20-3.01), body mass index (BMI, kg/m(2)) ≤18.5 (OR 1.91, 95% CI 1.11-3.29), and XDR-TB (OR 2.28, 95% CI 1.11-4.71). Patients who underwent surgical resection (OR 0.27, 95% CI 0.11-0.64) and had sputum culture conversion by 4 months (OR 0.33, 95% CI 0.21-0.52) were significantly less likely to have poor treatment outcomes.
  
  
  CONCLUSIONS
  Adjunctive surgery appeared to be beneficial in treating patients with M/XDR-TB. Retreatment cases, XDR-TB, bilateral disease, and low BMI were associated with a poor outcome. Additional studies are needed to further define the apparent beneficial role of surgery in the treatment of M/XDR-TB.
authors.affiliation: The National Center for Tuberculosis and Lung Diseases and Georgian National TB Program, 50 Maruashvili Street, Tbilisi 0101, Georgia. mgegia@gmail.com
authors.forename: Medea
authors.initials: M
authors.lastname: Gegia
authors.forename: Iagor
authors.initials: I
authors.lastname: Kalandadze
authors.forename: Russel R
authors.initials: RR
authors.lastname: Kempker
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Magee
authors.forename: Henry M
authors.initials: HM
authors.lastname: Blumberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000904:Antibiotics, Antitubercular / Q000494:pharmacology; D005260:Female; D005846:Georgia (Republic) / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009169:Mycobacterium tuberculosis / Q000187:drug effects*; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D055815:Young Adult
chemical_list: D000904:Antibiotics, Antitubercular