title: Survival of patients with multidrug-resistant TB in Eastern Europe: what makes a difference?
abstract: The quality of care for patients with TB in Eastern Europe has improved significantly; nevertheless drug resistance rates remain high. We analysed survival in a cohort of patients with multidrug-resistant and extensively drug-resistant (MDR-/XDR-) TB from Latvia, Lithuania, Estonia and Bucharest city.
  
  
  
  Consecutive adult new and retreatment patients with culture-confirmed pulmonary MDR-TB registered for treatment in 2009 (and in 2007 in Latvia) were enrolled; prospective survival information was collected.
  
  
  
  A total of 737 patients were included into the cohort. Of all MDR-TB cases, 46% were newly diagnosed; 56% of all MDR-TB cases had no additional resistance to fluoroquinolones or injectable agents, 33% had pre-XDR-TB and 11% XDR-TB. Median survival was 5.9 years in patients with MDR-TB and XDR-TB; 1.9 years in patients coinfected with HIV. Older age, male gender, alcohol abuse, retirement, co-morbidities, extrapulmonary involvement and HIV coinfection independently worsened survival. Inclusion of fluoroquinolones and injectable agents improves survival in patients with MDR-TB. Pre-XDR and XDR status did not significantly shorten survival as long as fluoroquinolones and injectable agents were part of the regimen. Moxifloxacin seems to improve survival in ofloxacin-susceptible patients when compared with older generation fluoroquinolones.
  
  
  
  The burden of additional resistances in patients with MDR-TB is high likely due to primary transmission of resistant strains. Social and programmatic factors including management of alcohol dependency, expansion of HIV testing and antiretroviral treatment need to be addressed in order to achieve cure and to interrupt transmission. The role of last generation fluoroquinolones and injectable agents in treatment of patients with pre-XDR and XDR-TB needs to be further investigated.
authors.affiliation: Blizard Institute, Queen Mary, University of London, London, UK Department of Infectious Diseases, Imperial College London, London, UK Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
authors.forename: Yanina
authors.initials: Y
authors.lastname: Balabanova
authors.affiliation: N.V. Postnikov Samara Region Clinical Tuberculosis Dispensary, Samara, Russia.
authors.forename: Olga
authors.initials: O
authors.lastname: Ignatyeva
authors.affiliation: Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
authors.forename: Lena
authors.initials: L
authors.lastname: Fiebig
authors.affiliation: Department of Mycobacteriology, State Agency "Infectology Center of Latvia", Clinic for Tuberculosis and Lung Diseases, "Upeslejas" Stopinunovads, Riga, Latvia.
authors.forename: Vija
authors.initials: V
authors.lastname: Riekstina
authors.affiliation: United Laboratory, Department of Mycobacteriology, Tartu University Hospital, Tartu, Estonia.
authors.forename: Manfred
authors.initials: M
authors.lastname: Danilovits
authors.affiliation: United Laboratory, Department of Mycobacteriology, Tartu University Hospital, Tartu, Estonia.
authors.forename: Kadri
authors.initials: K
authors.lastname: Jaama
authors.affiliation: National Tuberculosis and Infectious Diseases University Hospital, Vilnius, Lithuania.
authors.forename: Edita
authors.initials: E
authors.lastname: Davidaviciene
authors.affiliation: National Tuberculosis and Infectious Diseases University Hospital, Vilnius, Lithuania.
authors.forename: Birute
authors.initials: B
authors.lastname: Radiulyte
authors.affiliation: Marius Nasta Institute of Pneumology, Bucharest, Romania.
authors.forename: Christina Marcela
authors.initials: CM
authors.lastname: Popa
authors.affiliation: Blizard Institute, Queen Mary, University of London, London, UK Department of Infectious Diseases, Imperial College London, London, UK.
authors.forename: Vladyslav
authors.initials: V
authors.lastname: Nikolayevskyy
authors.affiliation: Blizard Institute, Queen Mary, University of London, London, UK Department of Infectious Diseases, Imperial College London, London, UK.
authors.forename: Francis
authors.initials: F
authors.lastname: Drobniewski
mesh_terms: D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D024901:Drug Resistance, Multiple, Bacterial; D004359:Drug Therapy, Combination; D005061:Europe, Eastern / Q000453:epidemiology; D054908:Extensively Drug-Resistant Tuberculosis / Q000188:drug therapy / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy / Q000401:mortality*; D014397:Tuberculosis, Pulmonary / Q000401:mortality*; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents
keywords: Tuberculosis