Predictors of poor outcomes among patients treated for multidrug-resistant tuberculosis at DOTS-plus projects.
The Objective of this analysis was to identify predictors of death, failure, and default among MDR-TB patients treated with second-line drugs in DOTS-plus projects in Estonia, Latvia, Philippines, Russia, and Peru, 2000-2004. Risk ratios (RR) with 95% confidence intervals (CI) were calculated using multivariable regression. Of 1768 patients, treatment outcomes were: cure/completed - 1156 (65%), died - 200 (11%), default - 241 (14%), failure - 118 (7%). Independent predictors of death included: age>45 years (RR = 1.90 (95%CI 1.29-2.80), HIV infection (RR = 4.22 (2.65-6.72)), extrapulmonary disease (RR = 1.54 (1.04-2.26)), BMI<18.5 (RR = 2.71 (1.91-3.85)), previous use of fluoroquinolones (RR = 1.91 (1.31-2.78)), resistance to any thioamide (RR = 1.59 (1.14-2.22)), baseline positive smear (RR = 2.22 (1.60-3.10)), no culture conversion by 3rd month of treatment (RR = 1.69 (1.19-2.41)); failure: cavitary disease (RR = 1.73 (1.07-2.80)), resistance to any fluoroquinolone (RR = 2.73 (1.71-4.37)) and any thioamide (RR = 1.62 (1.12-2.34)), and no culture conversion by 3rd month (RR = 5.84 (3.02-11.27)); default: unemployment (RR = 1.50 (1.12-2.01)), homelessness (RR = 1.52 (1.00-2.31)), imprisonment (RR = 1.86 (1.42-2.45)), alcohol abuse (RR = 1.60 (1.18-2.16)), and baseline positive smear (RR = 1.35 (1.07-1.71)). Patients with biomedical risk factors for treatment failure or death should receive heightened medical attention. To prevent treatment default, management of patients who are unemployed, homeless, alcoholic, or have a prison history requires extra measures to insure treatment completion.
U.S. Centers for Disease Control and Prevention, International Research and Programs Branch, Division of Tuberculosis Elimination, Atlanta, GA 30333, USA. EKurbatova@cdc.gov
Ekaterina V
EV
Kurbatova
Allison
A
Taylor
Victoria M
VM
Gammino
Jaime
J
Bayona
Mercedes
M
Becerra
Manfred
M
Danilovitz
Dennis
D
Falzon
Irina
I
Gelmanova
Salmaan
S
Keshavjee
Vaira
V
Leimane
Carole D
CD
Mitnick
Ma Imelda
MI
Quelapio
Vija
V
Riekstina
Piret
P
Viiklepp
Matteo
M
Zignol
J Peter
JP
Cegielski
D000328:Adult; D000367:Age Factors; D000995:Antitubercular Agents / Q000008:administration & dosage*; D015992:Body Mass Index; D023801:Directly Observed Therapy; D004957:Estonia / Q000453:epidemiology; D005260:Female; D006679:HIV Seropositivity / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D007844:Latvia / Q000453:epidemiology; D008297:Male; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D010568:Peru / Q000453:epidemiology; D010679:Philippines / Q000453:epidemiology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012426:Russia / Q000453:epidemiology; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000453:epidemiology*; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality
D000995:Antitubercular Agents