title: Impact of Multidrug Resistance on Tuberculosis Recurrence and Long-Term Outcome in China.
abstract: Little is known about the impact of drug resistance on recurrence in TB. We conducted a cohort study to measure the impact of multi-drug resistance (MDR) on TB recurrence over nine years in Henan Province China. We reviewed medical records and conducted field interviews of 100 MDR and 150 non-MDR TB patients who were treated between 2001 and 2002. We compared long-term recurrence rates, risk factors, and outcomes in 2010 for 234 individuals who could be followed up. About one third (29.5%, 69/234) suffered recurrence after completion of treatment. The overall recurrence rate was 35/1,000 patient-years (PY), with a much higher rate (65/1,000 PY) among MDR-TB patients. MDR (HR: 2.75; CI: 1.58-4.79) and patient annual household income less than 10,000 Yuan (HR: 2.05; CI 1.11-3.80) were associated with recurrence. The mean time for recurrence among MDR-TB patients was 5.7 years, compared to 7.2 years among non-MDR-TB patients. Among the recurrence group members, 61.3% died, and 18.8% had failed treatments. We believe that the high TB recurrence rate after 9 years suggests that a high cure rate cannot accurately predict long-term outcome. We recommend that TB surveillance and control should be strengthened with a focus on MDR-TB and directly observed treatment, to reduce TB recurrence and transmission of MDR-TB.
authors.affiliation: National Centre for Epidemiology and Population Health, Research School of Population Health, ANU College of Medicine, Biology and Environment, The Australian National University, Canberra, ACT, Australia.
authors.forename: Yanni
authors.initials: Y
authors.lastname: Sun
authors.affiliation: National Centre for Epidemiology and Population Health, Research School of Population Health, ANU College of Medicine, Biology and Environment, The Australian National University, Canberra, ACT, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Harley
authors.affiliation: School of Public Health & Human Biosciences, La Trobe University, Melbourne, Victoria, Australia.
authors.forename: Hassan
authors.initials: H
authors.lastname: Vally
authors.affiliation: National Centre for Epidemiology and Population Health, Research School of Population Health, ANU College of Medicine, Biology and Environment, The Australian National University, Canberra, ACT, Australia.
authors.forename: Adrian
authors.initials: A
authors.lastname: Sleigh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000382:Agricultural Workers' Diseases / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology; D000995:Antitubercular Agents / Q000494:pharmacology / Q000627:therapeutic use; D002681:China / Q000453:epidemiology; D015897:Comorbidity; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007182:Income; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects*; D012008:Recurrence; D012307:Risk Factors; D012494:Sampling Studies; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents