title: Multi- and extensively drug-resistant tuberculosis in Latvia: trends, characteristics and treatment outcomes.
abstract: METHODS
  Drug-resistant tuberculosis (TB) is an important public health problem in Latvia.
  
  
  OBJECTIVE
  To document trends, characteristics and treatment outcomes of registered patients with multi-drug-resistant (MDR-) and extensively drug-resistant (XDR-) TB in Latvia from 2000 to 2010.
  
  
  METHODS
  A retrospective national cohort study.
  
  
  RESULTS
  Of 1779 patients, 1646 (92%) had MDR- and 133 (8%) XDR-TB. Over 11 years, the proportion of XDR-TB among MDR-TB patients increased from 2% to 18%. Compared to MDR-TB patients, those with XDR-TB were significantly more likely to have failed MDR-TB treatment (OR 8.4, 95%CI 4.3-16.2), have human immunodeficiency virus infection (OR 3.2, 95%CI 1.8-5.7), be illegal drug users (OR 5.7, 95%CI 2.6-11.6) or have had contact with MDR-TB patients (OR 1.9, 95%CI 1.3-2.8). Cure rates for XDR-TB were 50%. Compared with MDR-TB patients, those with XDR-TB had a higher risk of treatment failure (29% vs. 8%, respectively, P < 0.001). Unfavourable treatment outcomes were significantly associated with being male; having smear-positive disease; pulmonary cavities; failure, default or relapse after previous MDR-TB treatment; and a history of incarceration.
  
  
  CONCLUSIONS
  More MDR-TB in Latvia is now also XDR-TB. This study identified several risk factors for XDR-TB and, for unfavourable treatment outcomes, highlighting the importance of early diagnosis and appropriate management of MDR-/XDR-TB.
authors.affiliation: Riga East University Hospital TB and Lung Disease Centre, Riga, Latvia ; Riga Stradins University, Riga, Latvia.
authors.forename: L
authors.initials: L
authors.lastname: Kuksa
authors.affiliation: Riga East University Hospital TB and Lung Disease Centre, Riga, Latvia.
authors.forename: V
authors.initials: V
authors.lastname: Riekstina
authors.affiliation: Riga East University Hospital TB and Lung Disease Centre, Riga, Latvia.
authors.forename: V
authors.initials: V
authors.lastname: Leimane
authors.affiliation: Riga East University Hospital TB and Lung Disease Centre, Riga, Latvia ; Riga Stradins University, Riga, Latvia.
authors.forename: I
authors.initials: I
authors.lastname: Ozere
authors.affiliation: Riga East University Hospital TB and Lung Disease Centre, Riga, Latvia.
authors.forename: G
authors.initials: G
authors.lastname: Skenders
authors.affiliation: Medical Department, Operational Center Brussels, Médecins Sans Frontières, MSF-Luxembourg, Luxembourg.
authors.forename: R
authors.initials: R
authors.lastname: Van den Bergh
authors.affiliation: Tuberculosis and M/XDR-TB Programme, Division of Communicable Diseases, Health Security & Environment, World Health Organization Regional Office for Europe, Copenhagen, Denmark.
authors.forename: K
authors.initials: K
authors.lastname: Kremer
authors.affiliation: Tuberculosis and M/XDR-TB Programme, Division of Communicable Diseases, Health Security & Environment, World Health Organization Regional Office for Europe, Copenhagen, Denmark.
authors.forename: C D
authors.initials: CD
authors.lastname: Acosta
authors.affiliation: International Union Against Tuberculosis and Lung Disease, Paris, France ; London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: A D
authors.initials: AD
authors.lastname: Harries
keywords: Europe; Latvia; SORT IT; XDR-TB; operational research