title: Treatment outcomes of multidrug-resistant tuberculosis in Switzerland.
abstract: OBJECTIVE
  To assess outcomes 24 months after treatment start for multidrug-resistant tuberculosis (MDR-TB).
  
  
  METHODS
  Cohort study of all culture-positive MDR-TB cases notified in Switzerland from 01/2003 to 07/2010.
  
  
  RESULTS
  Fifty-one cases were observed, with a median age of 26 years (range 2-56). Twenty-seven were male, five of Swiss origin, 46 of foreign origin (Asia 18, Africa 13, former Soviet Union 8), including 21 asylum seekers and refugees. Twelve had received a previous treatment for TB and 24 had not (15 unknown). Forty-four cases were pulmonary of which 25 were known to be sputum smear positive. All but two strains showed additional resistances: 29 to ethambutol, 27 to pyrazinamide, 6 to a fluoroquinolone, 5 to amikacin. None was resistant to both of the latter two classes. Molecular analyses showed three pairs of identical strains. Fluoroquinolones were used in 48 patients and second-line injectable drugs in 37. The median duration of MDR treatment was 18 months (range 1-26). The outcome after 24 months was successful in 39 (76%) and unsatisfactory in 12 (24%) patients: two deaths from TB; two treatments terminated owing to side effects of drugs and one owing to pregnancy; four defaults from treatment at months 0, 4, 8, and 21; two transfers abroad with unknown outcome; one outcome unknown. There was no significant association of unfavourable outcomes with age, sex, origin, previous treatment, treatment delay, resistance pattern, and classes of drugs used.
  
  
  CONCLUSIONS
  MDR-TB in Switzerland occurs mostly in persons of foreign origin. Results of decentralised treatments were satisfactory.
authors.affiliation: Federal Office of Public Health, Bern, Switzerland.
authors.forename: Peter
authors.initials: P
authors.lastname: Helbling
authors.affiliation: Federal Office of Public Health, Bern, Switzerland.
authors.forename: Ekkehardt
authors.initials: E
authors.lastname: Altpeter
authors.affiliation: Swiss Lung Association, Bern, Switzerland.
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Egger
authors.affiliation: Swiss Lung Association, Bern, Switzerland.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Zellweger
mesh_terms: D000293:Adolescent; D000328:Adult; D000904:Antibiotics, Antitubercular / Q000494:pharmacology / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D058889:Molecular Typing; D009169:Mycobacterium tuberculosis / Q000145:classification / Q000187:drug effects*; D012189:Retrospective Studies; D013557:Switzerland; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy* / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000382:microbiology; D055815:Young Adult
chemical_list: D000904:Antibiotics, Antitubercular; D000995:Antitubercular Agents