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Treatment Outcomes and Long-term Survival in Patients with Extensively Drug-resistant Tuberculosis

¹ Department of Internal Medicine, Dankook University College of Medicine, Dankook University Hospital, Cheonan, South Korea; ² Department of Epidemiology, The Korean Institute of Tuberculosis, Seoul, South Korea; ³ Clinical Research Center, National Masan Hospital, Masan, South Korea; ⁴ Division of Clinical Research, International Tuberculosis Research Center, Masan, South Korea; ⁵ Department of Thoracic Surgery, Mokpo National Hospital, Mokpo, South Korea; ⁶ Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea; ⁷ Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea; ⁸ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Pochon CHA University, Seongnam, South Korea; ⁹ Department of Internal Medicine, Chungbuk National University College of Medicine, Chungbuk National University Hospital, Cheongju, South Korea; ¹⁰ Department of Internal Medicine, Inje University School of Medicine, Ilsan Paik Hospital, Goyang, South Korea; ¹¹ Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea; ¹² Division of HIV and TB Control, Department of Disease Prevention, Korea Centers for Disease Control and Prevention, South Korea; ¹³ Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea

Correspondence and requests for reprints should be addressed to Tae Sun Shim, M.D., Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap-dong, Songpa-gu, Seoul, 138-736, South Korea. E-mail: shimts{at}amc.seoul.kr

Rationale: The increasing worldwide incidence of extensively drug-resistant tuberculosis (XDR-TB) has emerged as a threat to public health and tuberculosis (TB) control. Treatment outcomes have varied among studies, and data on long-term survival are still scarce.

Objectives: To retrospectively assess the burden, clinical characteristics, treatment outcomes, and long-term survival rate of patients with XDR-TB in a cohort of patients with HIV-negative multidrug-resistant tuberculosis (MDR-TB) in South Korea.

Methods: Medical records were reviewed of patients newly diagnosed with or retreated for MDR-TB from 2000 to 2002. The cohort was monitored for 3 to 7 years after the initiation of treatment. Initial treatment outcomes and cumulative survival rates were analyzed, and predictors of treatment success and survival were defined.

Measurements and Main Results: Of 1,407 patients with MDR-TB 75 (5.3%) had XDR-TB at treatment initiation. The default rate was high (453/1,407; 32%), and patients with XDR-TB had lower treatment success (29.3 vs. 46.2%; P = 0.004) and higher all-cause (49.3 vs. 19.4%; P < 0.001) and TB-related disease mortality (41.3 vs. 11.8%; P < 0.001) than other patients with MDR-TB. The presence of XDR-TB significantly affected treatment success (odds ratio, 0.23; 95% confidence interval [CI], 0.08–0.64; P = 0.005), all-cause mortality (hazards ratio, 3.25; 95% CI, 1.91–5.53; P < 0.001), and TB-related mortality (hazards ratio, 4.45; 95% CI, 2.48–8.00; P < 0.001) on multivariate analyses.

Conclusions: XDR-TB occurred in a substantial proportion of patients with MDR-TB in South Korea, and was the strongest predictor of treatment outcomes and long-term survival in patients with MDR-TB. Adequate TB control policies should be implemented to prevent the further development and spread of drug resistance.

Key Words: tuberculosis • extensively drug-resistant tuberculosis • tuberculosis survival rate • treatment efficacy • South Korea

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject Although the increasing worldwide incidence of extensively drug-resistant tuberculosis (XDR-TB) has emerged as a threat to public health and tuberculosis control, the results of treatment outcomes have varied among studies and the data on long-term survival of patients of XDR-TB patients are still scarce. What This Study Adds to the Field Our study indicated that XDR-TB was the strongest predictor of poor treatment outcomes and long-term mortality in patients with multidrug-resistant TB.

 

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