title: Baseline Predictors of Treatment Outcomes in Children With Multidrug-Resistant Tuberculosis: A Retrospective Cohort Study.
abstract: Globally, >30 000 children fall sick with multidrug-resistant (MDR) tuberculosis every year. Without robust pediatric data, clinical management follows international guidelines that are based on studies in adults and expert opinion. We aimed to identify baseline predictors of death, treatment failure, and loss to follow-up among children with MDR tuberculosis disease treated with regimens tailored to their drug susceptibility test (DST) result or to the DST result of a source case.
  
  
  
  This retrospective cohort study included all children ≤15 years old with confirmed and probable MDR tuberculosis disease who began tailored regimens in Lima, Peru, between 2005 and 2009. Using logistic regression, we examined associations between baseline patient and treatment characteristics and (1) death or treatment failure and (2) loss to follow-up.
  
  
  
  Two hundred eleven of 232 (90.9%) children had known treatment outcomes, of whom 163 (77.2%) achieved cure or probable cure, 29 (13.7%) were lost to follow-up, 10 (4.7%) experienced treatment failure, and 9 (4.3%) died. Independent baseline predictors of death or treatment failure were the presence of severe disease (adjusted odds ratio [aOR], 4.96; 95% confidence interval [CI], 1.61-15.26) and z score ≤-1 (aOR, 3.39; 95% CI, 1.20-9.54). We did not identify any independent predictors of loss to follow-up.
  
  
  
  High cure rates can be achieved in children with MDR tuberculosis using tailored regimens containing second-line drugs. However, children faced significantly higher risk of death or treatment failure if they had severe disease or were underweight. These findings highlight the need for early interventions that can improve treatment outcomes for children with MDR tuberculosis.
authors.affiliation: Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.
authors.forename: Silvia S
authors.initials: SS
authors.lastname: Chiang
authors.affiliation: Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas.
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Starke
authors.affiliation: Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.
authors.forename: Ann C
authors.initials: AC
authors.lastname: Miller
authors.affiliation: Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, Houston, Texas.
authors.forename: Andrea T
authors.initials: AT
authors.lastname: Cruz
authors.affiliation: Instituto Nacional de Salud del Niño.
authors.forename: Hernán
authors.initials: H
authors.lastname: Del Castillo
authors.affiliation: Partners In Health (Socios En Salud Sucursal Peru).
authors.forename: William José
authors.initials: WJ
authors.lastname: Valdivia
authors.affiliation: Partners In Health (Socios En Salud Sucursal Peru).
authors.forename: Gabriela
authors.initials: G
authors.lastname: Tunque
authors.affiliation: Partners In Health (Socios En Salud Sucursal Peru).
authors.forename: Fanny
authors.initials: F
authors.lastname: García
authors.affiliation: Partners In Health (Socios En Salud Sucursal Peru).
authors.forename: Carmen
authors.initials: C
authors.lastname: Contreras
authors.affiliation: Partners In Health (Socios En Salud Sucursal Peru).
authors.forename: Leonid
authors.initials: L
authors.lastname: Lecca
authors.affiliation: Estrategia Sanitaria Nacional de Prevención y Control de la Tuberculosis, Ministerio de Salud, Lima, Peru.
authors.forename: Valentina A
authors.initials: VA
authors.lastname: Alarcón
authors.affiliation: Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts Partners In Health (Socios En Salud Sucursal Peru).
authors.forename: Mercedes C
authors.initials: MC
authors.lastname: Becerra
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000995:Antitubercular Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005838:Genotype; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D059012:Lost to Follow-Up; D008297:Male; D008826:Microbial Sensitivity Tests; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000235:genetics; D010568:Peru; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D017211:Treatment Failure; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality
chemical_list: D000995:Antitubercular Agents
keywords: South America; adolescent tuberculosis; childhood tuberculosis; multidrug-resistant tuberculosis; nutrition