title: Tuberculosis drug resistance and outcomes among tuberculosis inpatients in Lilongwe, Malawi.
abstract: SETTING/OBJECTIVE: We evaluated clinical characteristics, yield of solid vs. liquid culture, polymerase chain reaction (PCR)-based drug-resistance profiles, and clinical outcomes of tuberculosis (TB) inpatients in Lilongwe, Malawi.
  
  
  METHODS
  We enrolled adult patients admitted to the Bwaila TB Ward from Jan-Aug/2010. Evaluations included questionnaires, clinical exam, chest radiograph, HIV status, CD4 lymphocyte count, plasma HIVRNA and sputum analysis including Auramine-O stain, Lowenstein-Jensen (LJ) and Mycobacterial Growth Indicator Tube (MGIT) culture, and susceptibility testing using the HAIN GenoType® MTBDRplus.
  
  
  RESULTS
  Eighty-eight patients were enrolled (88% re-treatment, 42% smear positive, 93% pulmonary TB, 74% HIV co-infected). At baseline, 44/88 (50%) MGIT and 28 (32%) LJ cultures were positive with a mean time to positivity of 12.1 (Range 1-42) and 21.5 (Range 7-58) days, respectively. Four percent (3/77) of retreatment patients or 8% of the 38 MGIT+ PCR-confirmed retreatment cases had multi-drug resistant tuberculosis (MDR TB). One MDR TB patient was smear negative and only one MDR patient was identified with LJ. Lower mean hemoglobin at admission was associated with mortality (10.5 vs. 7.5; p<0.01; CI 101 9.8-11.0).
  
  
  CONCLUSIONS
  The MDR TB burden among the retreatment population in Lilongwe, Malawi is similar to regional estimates by the WHO (7.7% 95% CI 0-18.1). MDR TB patients are not routinely identified with sputum smear or LJ, suggesting more efficient technology should be adopted.
authors: University of North Carolina Hospitals Department of Medicine.
authors: Charles
authors: C
authors: Vorkas
authors: Dumbani
authors: D
authors: Kayira
authors: Charles
authors: C
authors: van der Horst
authors: Irving
authors: I
authors: Hoffman
authors: Mina
authors: M
authors: Hosseinipour
authors: Creto
authors: C
authors: Kanyemba
authors: Nelson
authors: N
authors: Nguluwe
authors: Tarsizio
authors: T
authors: Chikaonda
authors: Maximina
authors: M
authors: Kalikhoka
authors: Doreen
authors: D
authors: Kalaundi
authors: Dan
authors: D
authors: Namarika
authors: Peter
authors: P
authors: Gilligan
authors: Robert
authors: R
authors: Krysiak
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000494:pharmacology* / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D003470:Culture Media; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008826:Microbial Sensitivity Tests / Q000379:methods*; D008853:Microscopy / Q000379:methods; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D064887:Observational Studies as Topic; D016133:Polymerase Chain Reaction; D015995:Prevalence; D011446:Prospective Studies; D012367:RNA, Viral; D013183:Sputum / Q000382:microbiology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents; D003470:Culture Media; D012367:RNA, Viral
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