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Ann Am Thorac Soc. 2016 Aug;13(8):1271-8. doi: 10.1513/AnnalsATS.201512-845OC.

High Rates of Treatment Success in Pulmonary Multidrug-Resistant Tuberculosis by Individually Tailored Treatment Regimens.

Author information

1
1 Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany.
2
2 German Center for Infection Research, Clinical Tuberculosis Center, Borstel, Germany.
3
3 International Health/Infectious Diseases, University of Lübeck, Lübeck, Germany.
4
4 Department of Medicine, Karolinska Institute, Stockholm, Sweden.
5
5 Department of Internal Medicine, University of Namibia School of Medicine, Windhoek, Namibia.
6
6 Austrian Agency for Health and Food Safety (AGES), Vienna, Austria; and.
7
7 Department of Respiratory and Critical Care Medicine, Otto Wagner Hospital, Vienna, Austria.

Abstract

RATIONALE:

We evaluated whether treatment outcomes for patients with multidrug-resistant and extensively drug-resistant tuberculosis can be substantially improved when sufficient resources for personalizing medical care are available.

OBJECTIVES:

To describe the characteristics and outcomes of patients with pulmonary multidrug-resistant tuberculosis at the Otto Wagner Hospital in Vienna, Austria.

METHODS:

We conducted a retrospective single-center study of patients initiated on treatment for multi-drug resistant tuberculosis between January 2003 and December 2012 at the Otto Wagner Hospital, Vienna, Austria. The records of patients with multidrug-resistant tuberculosis were reviewed for epidemiological, clinical, laboratory, treatment, and outcome data.

MEASUREMENTS AND MAIN RESULTS:

Ninety patients with pulmonary multidrug-resistant tuberculosis were identified. The median age was 30 years (interquartile range, 26-37). All patients were of non-Austrian origin, and 70 (78%) came from former states of the Soviet Union. Thirty-nine (43%) patients had multidrug-resistant tuberculosis; 28 (31%) had additional bacillary resistance to at least one second-line injectable drug and 9 (10%) to a fluoroquinolone. Fourteen (16%) patients had extensively drug-resistant tuberculosis. Eighty-eight different drug combinations were used for the treatment of the 90 patients. Surgery was performed on 10 (11.1%) of the patients. Sixty-five (72.2%) patients had a successful treatment outcome, 8 (8.9%) defaulted, 3 (3.3%) died, 8 (8.9%) continued treatment in another country and their outcome was unknown, and 6 (6.7%) were still on therapy. None of the patients experienced treatment failure. Treatment outcomes for patients with extensively drug-resistant tuberculosis were similar to those of patients with multidrug-resistant tuberculosis.

CONCLUSIONS:

High rates of treatment success can be achieved in patients with multidrug-resistant and extensively drug-resistant tuberculosis when individually tailored treatment regimens can be provided in a high-resource setting.

KEYWORDS:

drug resistance; multidrug-resistant tuberculosis; outcome; treatment; tuberculosis

PMID:
27163360
DOI:
10.1513/AnnalsATS.201512-845OC
[Indexed for MEDLINE]

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