title: Recurrence after Successful Treatment of Multidrug-Resistant Tuberculosis in Taiwan.
abstract: Recurrence after successful treatment for multidrug-resistant tuberculosis (MDR-TB) is challenging because of limited retreatment options. This study aimed to determine rates and predictors of MDR-TB recurrence after successful treatment in Taiwan. Recurrence rates were analyzed by time from treatment completion in 295 M DR-TB patients in a national cohort. Factors associated with MDR-TB recurrence were examined using a multivariate Cox regression analysis. Ten (3%) patients experienced MDR-TB recurrence during a median follow-up of 4.8 years. The overall recurrence rate was 0.6 cases per 1000 person-months. Cavitation on chest radiography was an independent predictor of recurrence (adjusted hazard ratio [aHR] = 6.3; 95% CI, 1.2-34). When the analysis was restricted to 215 patients (73%) tested for second-line drug susceptibility, cavitation (aHR = 10.2; 95% CI, 1.2-89) and resistance patterns of extensively drug-resistant TB (XDR-TB) or pre-XDR-TB (aHR = 7.3; 95% CI, 1.2-44) were associated with increased risk of MDR-TB recurrence. In Taiwan, MDR-TB patients with cavitary lesions and resistance patterns of XDR-TB or pre-XDR-TB are at the highest risk of recurrence. These have important implications for MDR-TB programs aiming to optimize post-treatment follow-up and early detection of recurrent MDR-TB.
authors.affiliation: Office of Preventive Medicine, Centers for Disease Control, Taipei, Taiwan.
authors.forename: Meng-Yu
authors.identifier: http://orcid.org/0000-0001-7391-4581
authors.initials: MY
authors.lastname: Chen
authors.affiliation: Office of Preventive Medicine, Centers for Disease Control, Taipei, Taiwan.
authors.forename: Yi-Chun
authors.initials: YC
authors.lastname: Lo
authors.affiliation: Office of Preventive Medicine, Centers for Disease Control, Taipei, Taiwan.
authors.forename: Wan-Chin
authors.initials: WC
authors.lastname: Chen
authors.affiliation: Division of Chronic Infectious Diseases, Centers for Disease Control, Taipei, Taiwan.
authors.forename: Kwei-Feng
authors.initials: KF
authors.lastname: Wang
authors.affiliation: Division of Chronic Infectious Diseases, Centers for Disease Control, Taipei, Taiwan.|Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.|Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Pei-Chun
authors.initials: PC
authors.lastname: Chan
mesh_terms: D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use*; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009169:Mycobacterium tuberculosis; D013902:Radiography, Thoracic; D012008:Recurrence; D012189:Retrospective Studies; D013624:Taiwan; D018088:Tuberculosis, Multidrug-Resistant / Q000000981:diagnostic imaging / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents