title: Factors associated with treatment success and death in cases with multidrug-resistant tuberculosis in Bulgaria, 2009-2010.
abstract: OBJECTIVE
  To analyze determinants of success and death in multidrug-resistant tuberculosis patients (MDR-TB; resistance to, at least, isoniazid and rifampicin) placed on treatment in Bulgaria during the period September 2009 to March 2010 using logistic regression.
  
  
  RESULTS
  Fifty MDR-TB patients started treatment. Male:Female ratio was 2.3:1; mean age 43 years (range: 18-77); 19 patients (38%) were new; median duration of disease before treatment was 5 years (range: 1-13). All patients tested negative for HIV. Eight cases had XDR-TB (MDR-TB plus resistance to any fluoroquinolone and any second-line injectable). Twenty-four months after starting treatment, 24 patients (48%) had a successful outcome, in 6 (12%) treatment failed, 19 (38%) died, and one (2%) interrupted treatment. XDR-TB cases experienced higher mortality than others (75% vs. 30.9%, respectively, P<0.05). Sputum smear positivity at start of treatment and weight loss or no weight gain were positively associated with death (adjusted Odds ratio: 5.16; 95% confidence interval: 1.16-22.84 and 5.61; 1.48-21.20, respectively) and negatively with success (0.13; 0.02-0.94 and 0.02; 0.00-0.19). No previous TB treatment increased likelihood of success (7.82; 1.09-56.15).
  
  
  CONCLUSIONS
  Most MDR-TB patients in this first treatment cohort using WHO-recommended norms had advanced disease explaining the high mortality and low success. Early, adequate treatment of MDR-TB patients can improve outcomes and avert transmission.
authors.affiliation: University Hospital for Respiratory Diseases "St. Sofia", Sofia, Bulgaria. Electronic address: vlmilanov@yahoo.com.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Milanov
authors.affiliation: Global TB Programme, World Health Organization, Geneva, Switzerland.
authors.forename: Dennis
authors.initials: D
authors.lastname: Falzon
authors.affiliation: Public Health Directorate, Ministry of Health, Sofia, Bulgaria.
authors.forename: Mariya
authors.initials: M
authors.lastname: Zamfirova
authors.affiliation: Public Health Directorate, Ministry of Health, Sofia, Bulgaria.
authors.forename: Tonka
authors.initials: T
authors.lastname: Varleva
authors.affiliation: National Tuberculosis Reference Laboratory (NRL-TB), National Centre of Infectious and Parasitic Diseases (NCIPD), Sofia, Bulgaria.
authors.forename: Elizabeta
authors.initials: E
authors.lastname: Bachiyska
authors.affiliation: Specialized Hospital for Active Treatment of Lung Diseases, Gabrovo, Bulgaria.
authors.forename: Antoniya
authors.initials: A
authors.lastname: Koleva
authors.affiliation: World Health Organization Regional Office for Europe, Copenhagen, Denmark.
authors.forename: Masoud
authors.initials: M
authors.lastname: Dara
mesh_terms: D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use*; D002031:Bulgaria; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification / Q000502:physiology; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents
keywords: Bulgaria; Extensively drug resistant tuberculosis (XDR-TB); Multidrug-resistant tuberculosis (MDR-TB); Treatment outcome; Tuberculosis (TB)