title: Favorable outcomes for multidrug and extensively drug resistant tuberculosis patients undergoing surgery.
abstract: BACKGROUND
  New approaches are needed in the treatment of multidrug-resistant and extensively drug-resistant pulmonary tuberculosis (M/XDR-PTB). We evaluated the role of adjunctive surgical therapy in the treatment of M/XDR-PTB in the setting of directly observed treatment strategy (DOTS)-Plus implementation.
  
  
  METHODS
  We conducted an observational cohort study consisting of M/XDR-PTB patients who underwent thoracic surgery at the National Tuberculosis Center in Tbilisi, Georgia between October 2008 and February 2011. Indications for surgery included presence of M/XDR-PTB, localized pulmonary disease, fit to undergo surgery, and either medical treatment failure or such extensive drug resistance that failure was likely. Second-line anti-tuberculosis medical therapy was administered per World Health Organization (WHO) recommendations.
  
  
  RESULTS
  Seventy-five patients (51 MDR, 24 XDR) with PTB underwent adjunctive thoracic surgery. Median age was 30 years and average duration of preoperative M/XDR-PTB medical therapy was 342 days. The following surgical procedures were performed: pneumonectomy (11%), lobectomy (54%), and segmentectomy (35%). Mean postoperative follow-up time was 372 days. Of 72 patients with evaluable outcomes, 59 (82%) had favorable outcomes including 90% of MDR and 67% of XDR-TB patients. There was no postoperative mortality; postoperative complications occurred in 7 patients (9%). Risk factors for poor treatment outcomes in univariate analysis included bilateral disease, XDR, increasing effective drugs received, positive preoperative sputum culture, and major postoperative surgical complication.
  
  
  CONCLUSIONS
  Patients with M/XDR-PTB undergoing adjunctive thoracic surgery had high rates of favorable outcomes, no surgical-related mortality, and low rates of complications. Adjunctive surgery appears to play an important role in the treatment of select patients with M/XDR-PTB.
authors: National Center for Tuberculosis and Lung Diseases, Tbilisi, Republic of Georgia. sergovashakidze@yahoo.com
authors: Sergo
authors: S
authors: Vashakidze
authors: Shota
authors: S
authors: Gogishvili
authors: Ketino
authors: K
authors: Nikolaishvili
authors: Nino
authors: N
authors: Dzidzikashvili
authors: Nestani
authors: N
authors: Tukvadze
authors: Henry M
authors: HM
authors: Blumberg
authors: Russell R
authors: RR
authors: Kempker
mesh_terms: D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D054908:Extensively Drug-Resistant Tuberculosis / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005846:Georgia (Republic); D006801:Humans; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality / Q000601:surgery; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents
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