title: Drug resistant TB: UK multicentre study (DRUMS): Treatment, management and outcomes in London and West Midlands 2008-2014.
abstract: Detailed information regarding treatment practices and outcomes of MDR-TB treatment in the UK is required as a baseline for care improvements.
  
  
  
  100 consecutive cases between 2008 and 2014 were reviewed retrospectively at 4 MDR-TB treatment centres in England to obtain information on drug treatment choices, hospital admission duration and outcomes for MDR-TB.
  
  
  
  Initial hospital admission was long, median 62.5 (IQR 20-106, n = 92) days, and 13% (12/92) of patients lost their home during this period. Prolonged admission was associated with pulmonary cases, cavities on chest radiograph, a public health policy of waiting for sputum culture conversion (CC) and loss of the patient's home. Sputum CC occurred at a median of 33.5 (IQR 16-55, n = 46) days. Treatment success was high (74%, 74/100) and mortality low (1%, 1/100). A significant proportion of the cohort had "neutral" results due to deportation and transfer overseas (12%, (12/100)). 14% (14/100) had negative outcomes for which poor adherence was the main reason (62%, 9/14).
  
  
  
  Successful outcome is common in recognised centres and limited by adherence rather than microbiological failure. Duration of hospital admission is influenced by lack of suitable housing and some variation in public health practice. Wider access to long-term assisted living facilities could improve completion rates.
authors.affiliation: Institute for Infection and Immunity, St. George's University of London, London SW17 0RE, United Kingdom; Clinical Infection Unit, St George's Healthcare NHS Trust, London SW17 0QT, United Kingdom. Electronic address: amber.arnold@doctors.org.uk.
authors.forename: Amber
authors.initials: A
authors.lastname: Arnold
authors.affiliation: Division of Medicine, Imperial College London, United Kingdom.
authors.forename: Graham S
authors.initials: GS
authors.lastname: Cooke
authors.affiliation: Tuberculosis Service, St Mary's Hospital, Imperial College Healthcare NHS Trust, United Kingdom.
authors.forename: Onn Min
authors.initials: OM
authors.lastname: Kon
authors.affiliation: Department of Infectious Diseases, Heart of England Foundation Trust, Birmingham, United Kingdom.
authors.forename: Martin
authors.initials: M
authors.lastname: Dedicoat
authors.affiliation: Royal Free London NHS Foundation Trust and UCL Respiratory, Division of Medicine, University College London, United Kingdom.
authors.forename: Marc
authors.initials: M
authors.lastname: Lipman
authors.affiliation: Institute for Infection and Immunity, St. George's University of London, London SW17 0RE, United Kingdom.
authors.forename: Angela
authors.initials: A
authors.lastname: Loyse
authors.affiliation: Institute for Infection and Immunity, St. George's University of London, London SW17 0RE, United Kingdom.
authors.forename: Philip D
authors.initials: PD
authors.lastname: Butcher
authors.affiliation: Institute for Infection and Immunity, St. George's University of London, London SW17 0RE, United Kingdom.
authors.forename: Irina Chis
authors.initials: IC
authors.lastname: Ster
authors.affiliation: Institute for Infection and Immunity, St. George's University of London, London SW17 0RE, United Kingdom.
authors.forename: Thomas Stephen
authors.initials: TS
authors.lastname: Harrison
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D002985:Clinical Protocols; D019468:Disease Management; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007902:Length of Stay; D008131:London / Q000453:epidemiology; D008297:Male; D055118:Medication Adherence; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification; D012189:Retrospective Studies; D013183:Sputum / Q000382:microbiology; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000382:microbiology; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents
keywords: Tuberculosis