A cohort study on the outcome of multidrug-resistant tuberculosis among newly diagnosed cases / 中华传染病杂志

ABSTRACT

ObjectiveTo investigate the anti-tuberculosis treatment response and outcomes in treatment naive patients infected with multidrug-resistant tuberculosis (MDR-TB).MethodsA total of 408 patients who were diagnosed with MDR-TB in Shanghai Pulmonary Hospital from January 2006 to January 2009 were recruited in this study.These patients were divided into two groups based on their previous treatment history:treatment naive group and re treatment group. The treatment response,outcomes andadverse eventswere observed. The outcomes of thesetwo groupswere compared by cohort analysis and x2 test.ResultsThe sputum conversion rates,the lesions absorption rate and the cavity closing or shrinking rate of the treatment naive MDR TB group were significantly higher than those of the re treatment group,while the adverse events rate was not significantly different between two groups (x2 =0.434,P＞0.05).Among 89 treatment naive cases,66 cases (74.16％) were cured,8(8.99％) completed the full treatment course,7(7.87％) were treatment failure,3(3.37％) died,and 5(5.62％) were lost to follow-up.Among the 319 cases of re-treatment MDR TB group,134 (42.01％) were cured,31(9.72％) completed the full treatment course,116 (36.36％) were treatment failure,12(3.76％) died,26(8.15％) were lost to follow-up.The cure rate of the treatment naive MDR-TB group was significantly higher than that of re-treatment group (x2=28.783,P＜0.01).The factors influencing the treatment outcomes included the stage of the disease,the range of lesions and cavity, the patients'generalnutritional status, underlying complications,and the drug-resistant strains. Conclusions The anti-tuberculosis treatment outcomes are better in treatment naive patients with MDR-TB infection compared to the treatment experienced and retreated patients.Therefore,the status of the drug resistance should be closely monitored in order to detect MDR-TB as early as possible.With the early diagnosis,the treatmcnt regimen may be modified timely and as a result the treatment outcomes can be improved.