title: Effect of mycobacterial drug resistance patterns on patients' survival: a cohort study in Thailand.
abstract: BACKGROUND
  Drug resistance substantially increases tuberculosis (TB) mortality. This study aimed to describe the prevalence of mycobacterial drug resistance pattern and association of common resistance patterns with TB mortality in Thailand.
  
  
  METHODS
  A retrospective cohort study was conducted using TB surveillance data. A total of 9,518 culture-confirmed, pulmonary TB patients registered from 1 October 2004 to 31 December 2008 from the Thailand TB Active Surveillance Network were included in this study. Patients were followed up until TB treatment completion or death. Mycobacterial drug resistance patterns were categorized as pan-susceptible, rifampicin resistance, isoniazid monoresistance, and ethambutol/streptomycin resistance. Drug susceptibility testing (DST) was determined by Mycobacterial Growth Indicator Tube (MGIT) liquid culture systems. Survival analysis was applied.
  
  
  RESULTS
  Isoniazid monoresistance was the most common pattern, while rifampicin resistance had the largest impact on mortality. Cox regression analysis showed a significantly higher risk of death among patients with rifampicin resistance (adjusted hazard ratio (aHR) 1.9, 95% confident interval (CI), 1.5-2.5) and isoniazid monoresistance (aHR 1.4, 95% CI 1.1-1.7) than those with pan-susceptible group after adjustment for age, nationality, human immunodeficiency virus (HIV) and antiretroviral therapy (ART) status, diabetes mellitus, cavitary disease on chest x-ray, treatment observation, and province. HIV co-infection was associated with higher mortality in patients both on ART (aHR 1.9, 95% CI 1.5-2.5) and not on ART (aHR 8.1, 95% CI 6.8-9.8).
  
  
  CONCLUSIONS
  Rifampicin resistance and isoniazid monoresistance were associated with increased TB mortality. HIV-coinfection was associated with a higher risk of death including among those taking antiretroviral therapy.
authors.affiliation: Mahidol University. a_amornratp@yahoo.com.
authors.forename: Amornrat
authors.initials: A
authors.lastname: Anuwatnonthakate
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Whitehead
authors.forename: Jay K
authors.initials: JK
authors.lastname: Varma
authors.forename: Udomsak
authors.initials: U
authors.lastname: Silachamroon
authors.forename: Yuthichai
authors.initials: Y
authors.lastname: Kasetjaroen
authors.forename: Saiyud
authors.initials: S
authors.lastname: Moolphate
authors.forename: Pranom
authors.initials: P
authors.lastname: Limsomboon
authors.forename: Jiraphun
authors.initials: J
authors.lastname: Inyaphong
authors.forename: Narin
authors.initials: N
authors.lastname: Suriyon
authors.forename: Suporn
authors.initials: S
authors.lastname: Kavinum
authors.forename: Navarat
authors.initials: N
authors.lastname: Chiengson
authors.forename: Phatchara
authors.initials: P
authors.lastname: Tunteerapat
authors.forename: Jaranit
authors.initials: J
authors.lastname: Kaewkungwal
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007538:Isoniazid / Q000494:pharmacology / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012293:Rifampin / Q000494:pharmacology / Q000627:therapeutic use; D013785:Thailand / Q000453:epidemiology; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality*; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality*; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents; D000995:Antitubercular Agents; D007538:Isoniazid; D012293:Rifampin