Outcomes and follow-up of patients treated for multidrug-resistant tuberculosis in Orel, Russia, 2002-2005.
METHODS
Multidrug-resistant tuberculosis (MDR-TB) treatment facility, Orel Oblast, Russian Federation.


OBJECTIVE
To determine factors associated with poor outcome and to document status of patients after recording of TB outcomes.


METHODS
Retrospective review of prospective  single cohort.


RESULTS
Among 192 patients, factors significantly associated with poor outcome in multivariate analysis include three or more treatment interruptions during the intensive phase of therapy and alcohol or drug addiction (adjusted OR [aOR] 2.1, 95%CI 1.0-4.3 and aOR 1.9,  95%CI 1.0-3.7). Previous treatment was associated with poor outcome, but only among smear-positive patients (aOR 3.1, 95%CI 1.3-7.3). Ten patients (5%) developed extensively drug-resistant TB (XDR-TB) during treatment; of 115 patients with at least 6 months of follow-up data after  outcomes were recorded, 13 (11%) developed XDR-TB.


CONCLUSIONS
Interventions focused on supporting patient adherence during the intensive phase of treatment; the management of drug and alcohol addiction should be developed and studied. A substantial proportion of patients developed XDR-TB  during and after treatment. Longer term follow-up data of patients treated for MDR-TB are needed to better inform programmatic policy.
Division of Tuberculosis Elimination, US Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. hgi7@cdc.gov
J S
JS
Cavanaugh
B Y
BY
Kazennyy
M L
ML
Nguyen
E V
EV
Kiryanova
E
E
Vitek
T M
TM
Khorosheva
E
E
Nemtsova
J P
JP
Cegielski
D000293:Adolescent; D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000453:epidemiology; D000995:Antitubercular Agents / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D023801:Directly Observed Therapy; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D015999:Multivariate Analysis; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012426:Russia / Q000453:epidemiology; D013183:Sputum / Q000382:microbiology; D019966:Substance-Related Disorders / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D055815:Young Adult
D000995:Antitubercular Agents