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Published ahead of print on January 23, 2004, doi:10.1164/rccm.200308-1159OC

Am. J. Respir. Crit. Care Med., Volume 169, Number 10, May 2004, 1103-1109

A more recent version of this article appeared on May 15, 2004
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Submitted on August 21, 2003
Accepted on January 18, 2004

Treatment and Outcome Analysis of 205 Patients with Multidrug-Resistant Tuberculosis

Edward D Chan1, Valerie Laurel2, Matthew J Strand3, Julanie F Chan4, Mai-Lan N Huynh5, Marian Goble4, and Michael D Iseman6*

1 Medicine, National Jewish Medical and Research Center, Denver, CO, USA; Program in Cell Biology, National Jewish Medical and Research Center, Denver, CO, USA; Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Health Sciences Center, Denver, CO, USA, 2 Wilford Hall United States Air Force Medical Center, San Antonio, TX, USA, 3 Division of Biostatistics, National Jewish Medical and Research Center, Denver, CO, USA, 4 Medicine, National Jewish Medical and Research Center, Denver, CO, USA, 5 Medicine, National Jewish Medical and Research Center, Denver, CO, USA; Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Health Sciences Center, Denver, CO, USA, 6 Medicine, National Jewish Medical and Research Center, Denver, CO, USA; Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Health Sciences Center, Denver, CO, USA; Division of Infectious Diseases, University of Colorado Health Sciences Center, Denver, CO, USA

* To whom correspondence should be addressed. E-mail: isemanm{at}njc.org.

Multi-drug resistant tuberculosis (MDR-TB), disease due to Mycobacterium tuberculosis strains resistant at least to rifampin and isoniazid, entails extended treatment, expensive and toxic regimens, and higher rates of treatment failure and death. We retrospectively analyzed the outcomes in 205 patients treated at our center for MDR-TB, who were resistant to a median of 6 drugs, and compared the results to those of our previous series. Logistic regression and survival analysis were used to evaluate short-term and long-term outcomes, respectively. Initial favorable response, defined as at least three consecutive negative sputum cultures over a period of at least three months, was 85% compared to 65% in the prior cohort. The current cohort had greater long-term success rates, 75% vs 56%, and lower TB death rates, 12% vs 22%, than the earlier one. Surgical resection and fluoroquinolone therapy were associated with improved microbiological and clinical outcomes in the 205 patients studied after adjusting for other variables. The improvement was statistically significant for surgery and among older patients for fluoroquinolone therapy.
Key words: drug resistance, Mycobacterium tuberculosis, fluoroquinolones, surgery




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