title: Treatment outcomes of multidrug-resistant tuberculosis patients in Gauteng, South Africa.
abstract: OBJECTIVE
  Multidrug-resistant tuberculosis (MDR-TB) is associated with lengthy treatment, expensive and potentially toxic regimens, and high rates of treatment failure and death. This study describes the outcomes of 351 MDR-TB patients who started treatment between 2004 and 2007 at the provincial MDR-TB referral hospital in Johannesburg, South Africa, and investigates risk factors associated with death.
  
  
  METHODS
  The study involved the assessment of factors associated with treatment outcomes using a retrospective review of patient records, drug-susceptibility data and spoligotyping of isolates.
  
  
  RESULTS
  Treatment success (completion/cure) was recorded in 158 (48.8 %) patients, while 65 (20 %) died, 93 (28.7 %) defaulted, 8 (2.5 %) failed treatment, 11(3.1 %) were transferred out to other health facilities and 16 (4.6 %) had no recorded final outcome. The proportion of successful treatment increased significantly over time. Univariable and multivariable analysis (P = 0.05) identified the year of MDR-TB diagnosis and spoligotype-defined families as factors associated with treatment outcome. No associations were found between treatment outcome and human immunodeficiency virus (HIV) status, previous TB and additional MDR resistance to streptomycin or ethambutol. Molecular typing of the strains revealed a diverse group of spoligotypes, with Beijing, LAM4 and H3 making up the largest groups.
  
  
  CONCLUSIONS
  This is the first published study to investigate treatment outcomes at this facility and to find a link between genotype and treatment outcome, suggesting that genotype determination could potentially serve as a prognostic factor.
authors.affiliation: Department of Clinical Microbiology and Infectious Diseases, School of Pathology, University of the Witwatersrand and National Health Laboratory Service, Johannesburg, South Africa, else.marais@gmail.com.
authors.forename: E
authors.initials: E
authors.lastname: Marais
authors.forename: C K
authors.initials: CK
authors.lastname: Mlambo
authors.forename: J J
authors.initials: JJ
authors.lastname: Lewis
authors.forename: N
authors.initials: N
authors.lastname: Rastogi
authors.forename: T
authors.initials: T
authors.lastname: Zozio
authors.forename: M P
authors.initials: MP
authors.lastname: Grobusch
authors.forename: A
authors.initials: A
authors.lastname: Duse
authors.forename: T
authors.initials: T
authors.lastname: Victor
authors.forename: R W
authors.initials: RW
authors.lastname: Warren
mesh_terms: D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000494:pharmacology* / Q000627:therapeutic use*; D005260:Female; D005838:Genotype; D006801:Humans; D008297:Male; D009169:Mycobacterium tuberculosis / Q000187:drug effects* / Q000235:genetics; D012189:Retrospective Studies; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology; D017211:Treatment Failure; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents