title: Prognostic factors of treatment among patients with multidrug-resistant tuberculosis in Egypt.
abstract: OBJECTIVE
  Multidrug-resistant tuberculosis (MDR-TB) represents 5% of TB cases globally. In Egypt, it represents 11.4% of TB cases (2.2% of new and 38.2% of previously treated). Our objectives were to evaluate the treatment outcomes and determine the associated prognostic factors among the first national treatment cohort of MDR-TB from 2006 to 2010.
  
  
  METHODS
  All patients diagnosed with MDR-TB from July 2006 to December 2010 who were admitted to Abbassia Chest Hospital, the first Egyptian national center established for MDR-TB treatment, were included. They were followed up clinically, radiologically, and bacteriologically by sputum smear, culture, and drug-susceptibility testing at regular intervals. Individualized treatment regimens were prescribed according to each patient's drug-susceptibility testing and the drug treatment history. Patients received at least five effective drugs. Outcome rates, and crude and adjusted odds ratios of unsuccessful outcomes were calculated.
  
  
  RESULTS
  The number of bacteriologically proven MDR-TB patients was 228, of which 225 were pulmonary cases. Half of the cases showed moderate or extensive lung lesions, and 15.8% were diabetics. A total of 158 (119 cured and 39 completed treatment) patients achieved successful outcome (69.3%), 16 (7.1%) failed treatment, 27 (11.8%) were lost to follow up, and 27 (11.8%) died. Predictors of unsuccessful outcome were delay in sputum culture conversion to 2 months or more, moderate or extensive lung lesions, and a history of diabetes.
  
  
  CONCLUSIONS
  A treatment success rate of approximately 69% was achieved with the first national treatment cohort of MDR-TB under the Egyptian program. Predictors of unsuccessful treatment were delayed culture conversion, moderate or extensive lung affection, and diabetes.
authors.affiliation: Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
authors.forename: Mohsen A
authors.initials: MA
authors.lastname: Gadallah
authors.affiliation: Ministry of Health and Population, Chest Directorate, Abbassia Chest Hospital, Cairo, Egypt.
authors.forename: Alaa
authors.initials: A
authors.lastname: Mokhtar
authors.affiliation: Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
authors.forename: Mervat
authors.initials: M
authors.lastname: Rady
authors.affiliation: Ministry of Health and Population, Chest Directorate, Abbassia Chest Hospital, Cairo, Egypt.
authors.forename: Essam
authors.initials: E
authors.lastname: El-Moghazy
authors.affiliation: Ministry of Health and Population, Chest Directorate, Abbassia Chest Hospital, Cairo, Egypt.
authors.forename: Magdy
authors.initials: M
authors.lastname: Fawzy
authors.affiliation: Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt. Electronic address: sahar_kandil@yahoo.com.
authors.forename: Sahar Khalil
authors.initials: SK
authors.lastname: Kandil
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000145:classification / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D004534:Egypt; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D015999:Multivariate Analysis; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D011379:Prognosis; D013902:Radiography, Thoracic; D013183:Sputum / Q000382:microbiology; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents
keywords: multidrug-resistant tuberculosis; prognostic factors; treatment outcome; tuberculosis