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Clin Infect Dis. 2017 Feb 15;64(4):401-407. doi: 10.1093/cid/ciw763.

Long-term Mortality of Patients With Tuberculous Meningitis in New York City: A Cohort Study.

Author information

1
Public Health Research Institute, New Jersey Medical School, Newark, New Jersey, USA
2
New York City Department of Health and Mental Hygiene, Bureau of Tuberculosis Control, Queens, NY, USA.
3
University of Rochester School of Medicine and Dentistry, New York, USA.
4
Division of Infectious Disease Therapeutics, Kobe University, Japan.
5
Center for Infectious Disease Research and Experimental Therapeutics, Baylor University, Dallas, Texas, USA.

Abstract

Background:

Tuberculous meningitis (TBM) is the most devastating clinical presentation of infection with Mycobacterium tuberculosis; delayed initiation of effective antituberculosis therapy is associated with poor treatment outcomes. Our objective was to determine the relationship between drug resistance and 10-year mortality among patients with TBM.

Methods:

We conducted a retrospective cohort study of 324 patients with culture-confirmed TBM, susceptibility results reported for isoniazid and rifampin, and initiation of at least 2 antituberculosis drugs, reported to the tuberculosis registry in New York City between 1 January 1992 and 31 December 2001. Date of death was ascertained by matching the tuberculosis registry with death certificate data for 1992-2012 from the New York Office of Vital Statistics. Human immunodeficiency virus (HIV) status was ascertained by medical records review, matching with the New York City HIV Surveillance registry, and review of cause of death.

Results:

Among 257 TBM patients without rifampin-resistant isolates, isoniazid resistance was associated with mortality after the first 60 days of treatment when controlling for age and HIV infection (adjusted hazard ratio, 1.94 [95% confidence interval, 1.08-3.94]). Death occurred before completion of antituberculosis therapy in 63 of 67 TBM patients (94%) with rifampin-resistant disease.

Conclusions:

Among patients with culture-confirmed TBM, we observed rapid early mortality in patients with rifampin-resistant isolates, and an independent association between isoniazid-resistant isolates and death after 60 days of therapy. These findings support the continued evaluation of rapid diagnostic techniques and the empiric addition of second-line drugs for patients with clinically suspected drug-resistant TBM.

KEYWORDS:

drug resistance; multidrug resistance; treatment outcome; tuberculosis; tuberculous meningitis

PMID:
27927856
PMCID:
PMC5850536
DOI:
10.1093/cid/ciw763
[Indexed for MEDLINE]
Free PMC Article

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