title: Predictors of recurrence of multidrug-resistant and extensively drug-resistant tuberculosis.
abstract: OBJECTIVE
  To assess the treatment outcome of the first Green Light Committee (GLC) approved countrywide management of multidrug-resistant (MDR-) and extensively drug-resistant tuberculosis (XDR-TB) in Estonia and to evaluate risk factors contributing to TB recurrence over 8 years of  follow-up.
  
  
  METHODS
  Prospective assessment of MDR- and XDR-TB patients starting second-line anti-tuberculosis drug treatment between 1 August 2001 and 31 July 2003, with follow-up until 31 December 2010.
  
  
  RESULTS
  In 211 MDR- and XDR-TB patients, treatment success was 61.1%; 22.3% defaulted,  8.5% failed and 8.1% died. TB recurrence among successfully treated patients was 8.5%, with no significant difference between XDR-TB and MDR-TB. TB recurrence was associated with resistance to all injectables (HR 2.27, 95%CI 1.16-5.06, P = 0.046), resistance to a greater number  of drugs (HR 1.35, 95%CI 1.11-1.64, P = 0.003), and sputum smear positivity (HR 2.16, 95%CI 1.16-4.00, P = 0.016). A history of previous TB treatment was associated with TB recurrence among successfully treated patients (HR 4.28, 95%CI 1.13-16.15, P =  0.032).
  
  
  CONCLUSIONS
  The internationally recommended Category IV treatment regimens are sufficiently effective to cure 75% of adherent MDR- and XDR-TB patients. A history of previous treatment, resistance to all injectable agents and resistance to a greater number of drugs increase the  recurrence of MDR- and XDR-TB.
authors: Lung Clinic, Tartu University Clinics, Tartu, Estonia. kaivink@kodu.ee
authors: K
authors: K
authors: Blöndal
authors: P
authors: P
authors: Viiklepp
authors: L J
authors: LJ
authors: Guðmundsson
authors: A
authors: A
authors: Altraja
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use*; D024901:Drug Resistance, Multiple, Bacterial; D004957:Estonia / Q000453:epidemiology; D054908:Extensively Drug-Resistant Tuberculosis / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D055118:Medication Adherence; D015999:Multivariate Analysis; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000302:isolation & purification; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D013183:Sputum / Q000382:microbiology; D013997:Time Factors; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality
chemical_list: D000995:Antitubercular Agents