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Chest. 1997 May;111(5):1162-7.

Retreatment tuberculosis cases. Factors associated with drug resistance and adverse outcomes.

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  • 1Servico de Pneumologia, Hospital Clementino Fraga Filho, da Universidade Federal do Rio de Janeiro, Brazil.

Abstract

STUDY OBJECTIVE:

Risk factors associated with treatment failure and multidrug-resistant tuberculosis (MDR-TB) were examined among HIV-seronegative patients who were previously treated for tuberculosis (TB).

DESIGN:

Prospective, cohort study of patients referred to the study hospital for retreatment of TB between March 1986 and March 1990.

PATIENTS:

The patients belonged to three groups, according to outcomes following their previous treatment: 37 patients who abandoned treatment or suffered relapse after completion of therapy (group A), 91 patients who failed to respond to the first-line drug regimen (group B), and 78 patients who failed to respond to the second-line drug regimen (group C).

RESULTS:

Patients with Mycobacterium tuberculosis strains resistant to rifampin and isoniazid were found in 2 (6%) in group A, 29 (33%) in group B, and 49 (65%) in group C. Cure was achieved in 77% in group A, 54% in group B, and 36% in group C. Death occurred in none of the patients in group A, 8% in group B, and 24% in group C. In a multivariate logistic regression analysis, unfavorable response (failure to sterilize sputum culture, death, and abandonment) was significantly associated with infection with a multidrug-resistant M tuberculosis strain (p = 0.0002), cavitary disease (p = 0.0029), or irregular use of medications (p < 0.0001).

CONCLUSIONS:

These observations show that a previous treatment outcome and current clinical and epidemiologic histories can be used to predict the development of MDR-TB and adverse outcomes in patients undergoing retreatment for TB. Such information may be useful for identifying appropriate patient candidates for programs such as directly observed therapy.

PMID:
9149564
[PubMed - indexed for MEDLINE]
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