Predictors of mortality among multidrug-resistant tuberculosis patients in central Ethiopia: a retrospective follow-up study

Abstract The burden of multidrug-resistant tuberculosis (MDR-TB) related to mortality in resource-poor countries remains high. This study aimed to estimate the incidence and predictors of death among MDR-TB patients in central Ethiopia. A retrospective follow-up study was conducted at three hospitals in the Amhara region on 451 patients receiving treatment for MDR-TB from September 2010 to January 2017. Data were collected from patient registration books, charts and computer databases. Data were fitted to a parametric frailty model and survival was expressed as an adjusted hazard ratio (AHR) with a 95% confidence interval (CI). The median follow-up time of participants was 20 months (interquartile range: 12, 22) and 46 (10.20%) of patients died during this period. The incidence rate of mortality was 7.42 (95% CI 5.56–9.91)/100 person-years. Older age (AHR = 1.04, 95% CI 1.01–1.08), inability to self-care (AHR = 13.71, 95% CI 5.46–34.40), co-morbidity (AHR = 5.74, 95% CI 2.19–15.08), low body mass index (AHR = 4.13, 95% CI 1.02–16.64), acute lung complications (AHR = 4.22, 95% CI 1.66–10.70) and lung consolidation at baseline (AHR = 5.27, 95% CI 1.06–26.18) were independent predictors of mortality. Most of the identified predictor factors of death in this study were considered to be avoidable if the TB programme had provided nutritional support for malnourished patients and ensured a close follow-up of the elderly, and patients with co-morbidities.

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Outcome of pulmonary multidrug-resistant tuberculosis: a 6-yr follow-up study

European Respiratory Journal ◽

10.1183/09031936.06.00125705 ◽

2006 ◽

Vol 28 (5) ◽

pp. 980-985 ◽

Cited By ~ 68

Author(s):

C-Y. Chiang ◽

D. A. Enarson ◽

M-C. Yu ◽

K-J. Bai ◽

R-M. Huang ◽

...

Keyword(s):

Multidrug Resistant ◽

Follow Up Study ◽

Resistant Tuberculosis ◽

Multidrug Resistant Tuberculosis

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Active surveillance for adverse events in patients on longer treatment regimens for multidrug-resistant tuberculosis in Viet Nam

PLoS ONE ◽

10.1371/journal.pone.0255357 ◽

2021 ◽

Vol 16 (9) ◽

pp. e0255357

Author(s):

Nguyen Bao Ngoc ◽

Hoa Vu Dinh ◽

Nguyen Thi Thuy ◽

Duong Van Quang ◽

Cao Thi Thu Huyen ◽

...

Keyword(s):

Risk Factors ◽

Adverse Events ◽

Bayesian Model Averaging ◽

Multidrug Resistant ◽

Treatment Regimens ◽

Tb Treatment ◽

Resistant Tuberculosis ◽

Multidrug Resistant Tuberculosis ◽

Mdr Tb

Objective Management of multidrug-resistant tuberculosis (MDR-TB) is a significant challenge to the global healthcare system due to the complexity and long duration of the MDR-TB treatment. This study analyzed the safety of patients on longer injectable-based MDR-TB treatment regimens using active pharmacovigilance data. Method We conducted an observational, prospective study based on active pharmacovigilance within the national TB program. A total of 659 MDR-TB patients were enrolled and followed up at 9 TB- hospitals in 9 provinces of all 3 regions in Vietnam between 2014 and 2016. Patients received a treatment regimen (standardized or individualized) based on their drug susceptibility test result and their treatment history. Baseline and follow-up information was collected at the start and during treatment. Adverse events (AE) were defined and classified as serious adverse events (SAEs) or otherwise. Multivariate Cox regression following the Iterative Bayesian Model Averaging algorithm was performed to identify factors associated with AE occurrence. Results Out of 659 patients assessed, 71.3% experienced at least one AE, and 17.5% suffered at least one SAE. The most common AEs were gastrointestinal disorders (38.5%), arthralgia (34.7%), and psychiatric disorders (30.0%). The proportion of patients with nephrotoxicity and hearing loss or vestibular disorders were 7.4% and 15.2%, respectively. 13.1% of patients required modifications or interruption of one or more drugs. In 77.7% of patients, treatment was completed successfully, while 9.3% lost to follow-up, in 3.0% treatment failed, and 7.4% died. Some significant risk factors for nephrotoxicity included diabetes mellitus (HR = 8.46 [1.91–37.42]), renal dysfunction (HR = 8.46 [1.91–37.42]), alcoholism (HR = 13.28 [5.04–34.99]), and a higher average daily dose of injectable drugs (HR = 1.28 [1.14–1.43]). Conclusion While a majority of patients on the longer injectable-based regimens experienced non-serious AEs during MDR-TB treatment, one in six patients experienced at least an SAE. Active TB drug-safety monitoring is useful to understand the safety of MDR-TB treatment and explore the risk factors for toxicity. All-oral, shorter MDR-TB regimens might be able to reduce the inconvenience, discomfort, and toxicity of such regimens and increase adherence and likelihood of successful completion.

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Survival of patients with multidrug-resistant tuberculosis in Central China: a retrospective cohort study

Epidemiology and Infection ◽

10.1017/s0950268820000485 ◽

2020 ◽

Vol 148 ◽

Author(s):

Jianjie Wang ◽

Meilan Zhou ◽

Zi Chen ◽

Cong Chen ◽

Gang Wu ◽

...

Keyword(s):

Risk Factors ◽

Regression Analysis ◽

Patient Survival ◽

Multidrug Resistant ◽

Central China ◽

Risk Of Death ◽

Resistant Tuberculosis ◽

Multidrug Resistant Tuberculosis ◽

Mdr Tb

Abstract The aim of this study was to evaluate long-term survival and risk factors associated with multidrug-resistant tuberculosis (MDR-TB) patient survival in Central China. Between December 2006 and June 2011, incident and retreatment adult MDR-TB patients were enrolled in the present study. Cox proportional hazard regression analysis was used to evaluate the risk factors affecting survival. The total follow-up period was 270 person-years (PY) for 356 MDR-TB cases in Wuhan. Of the 356 cases, 103 patients died, yielding an average case fatality rate of 381.2 per 1000 TB patients per year. Using adjusted Cox regression analysis, older age (adjusted hazard ratio (aHR) >3.0 starting from 30 years) and low education level (primary and middle school; aHR 1.67 (95% CI 1.01–2.77)) were independently associated with lower survival. Diabetes mellitus profoundly affected the survival of MDR-TB patients (aHR 1.95 (95% CI 1.30–2.93)). Our data demonstrate that coexistent diabetes significantly and negatively impacted MDR-TB patient survival. In addition, MDR-TB patients aged 60 years or older exhibited a greater risk of mortality during follow-up. Our findings emphasise that MDR-TB patients with comorbidities that increase their risk of death require additional medical interventions to reduce mortality.

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Adverse treatment outcomes in multidrug resistant tuberculosis go beyond the microbe-drug interaction: Results of a multiple correspondence analysis.

Biomédica ◽

10.7705/biomedica.5072 ◽

2020 ◽

Vol 40 (4) ◽

pp. 616-625

Author(s):

Ángela Tobón ◽

Johana Rueda ◽

Diego H. Cáceres ◽

Gloria I. Mejía ◽

Elsa M. Zapata ◽

...

Keyword(s):

Treatment Outcomes ◽

Treatment Success ◽

Multidrug Resistant ◽

Chronic Obstructive ◽

Resistant Tuberculosis ◽

Multidrug Resistant Tuberculosis ◽

Mdr Tb ◽

Poor Outcomes ◽

Lost To Follow Up

Introduction: Multidrug-resistant tuberculosis treatment is effective in 50% of patients due to several factors including antibiotic susceptibility of the microorganism, adverse treatment reactions, social factors, and associated comorbidities.Objectives: In this study, we describe the demographics, clinical characteristics, and factors associated with treatment outcomes in multidrug-resistant tuberculosis (MDR-TB) patients in Medellín, Colombia.Materials and methods: We conducted a retrospective analysis using data from patients diagnosed with MDR-TB attending Hospital La María in Medellín, Colombia, for treatment between 2010 and 2015. Patients were categorized as having successful (cured) or poor (failure, lost to follow-up, and death) treatment outcomes. Associations between demographic, clinical factors, laboratory results, treatment outcomes, and follow-up information were evaluated by univariate, multivariate, and multiple correspondence analyses.Results: Of the 128 patients with MDR-TB, 77 (60%) had successful outcomes. Of those with poor outcomes, 26 were lost to follow-up, 15 died, and 10 were treatment failures. Irregular treatment, the presence of comorbidities, and positive cultures after more than two months of treatment were associated with poor outcomes compared to successful ones (p<0.05 for all). The multiple correspondence analyses grouped patients who were lost to follow-up, had HIV, and drug addiction, as well as patients with treatment failure, irregular treatment, and chronic obstructive pulmonary disease.Conclusion: The recognition of factors affecting treatment is essential and was associated with treatment outcomes in this series of patients. Early identification of these factors should increase the rates of treatment success and contribute to MDR-TB control.

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Efficacy and safety of regimen containing bedaquiline in children with drug-resistant tuberculosis

Medical Council ◽

10.21518/2079-701x-2021-16-138-146 ◽

2021 ◽

pp. 138-146

Author(s):

V. A. Aksenova ◽

N. I. Klevno ◽

A. V. Kazakov ◽

D. A. Kudlay ◽

A. D. Pakhlavonova ◽

...

Keyword(s):

Multidrug Resistant ◽

Drug Resistant ◽

Efficacy And Safety ◽

Duration Of Treatment ◽

Drug Resistant Tuberculosis ◽

Children And Adolescent ◽

Resistant Tuberculosis ◽

Multidrug Resistant Tuberculosis ◽

Mdr Tb

Introduction. The treatment of children with multidrug-resistant and extensively drug-resistant tuberculosis (MDR / XDR-TB) is a difficult task due to many factors: the duration of treatment, the lack of drugs with children’s dosages, age restrictions (according to the drug instructions).Purpose of the study. To assess the efficacy and safety of regimen with the inclusion of bedaquiline in children and adolescent with respiratory tuberculosis with drug-resistant tuberculosis.Materials and methods. The study is prospective, cohort, non-comparative from the period 2017–2019. We included 24 patients aged 5 to 17 years with MDR-TB (established or suspected) began regimen containing bedaquiline for 24 weeks. The duration of observation of patients included in the study was 24 months.Results. We can state a sufficient level of safety of using the latter for 24 weeks: adverse events presumably associated directly with the intake of bedaquiline were noted in only 1 patient out of 24 (4.2%; 95% CI 0.7-20.3). The efficacy of a regimen containing bedaquiline in combination with other anti-tuberculosis reserve drugs is beyond doubt: positive clinical and radiological dynamics and cessation of bacterial excretion by the end of the 24-week course of treatment were noted in all patients included in the study. In the course of 2-year follow-up, no exacerbation of the tuberculous process was observed in any case. All patients achieved clinical cure of tuberculosis.Conclusion. Regimen containing bedaquiline for children aged 5–17 years with multidrug-resistant tuberculosis is effective and safe.

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Effects of Multidrug Resistant Tuberculosis Treatment on Patients’ Health Related Quality of Life: Results from a Follow Up Study

PLoS ONE ◽

10.1371/journal.pone.0159560 ◽

2016 ◽

Vol 11 (7) ◽

pp. e0159560 ◽

Cited By ~ 11

Author(s):

Nafees Ahmad ◽

Arshad Javaid ◽

Syed Azhar Syed Sulaiman ◽

Anila Basit ◽

Afsar Khan Afridi ◽

...

Keyword(s):

Quality Of Life ◽

Multidrug Resistant ◽

Health Related Quality ◽

Follow Up Study ◽

Resistant Tuberculosis ◽

Multidrug Resistant Tuberculosis ◽

Related Quality ◽

Health Related

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Survival and predictors of mortality from multidrug resistant tuberculosis (MDR-TB) among patients treated at MDR-TB Referal Hospitals in Ethiopia: A retrospective cohort study

Journal of Public Health and Epidemiology ◽

10.5897/jphe2019.1129 ◽

2020 ◽

Vol 12 (1) ◽

pp. 13-21 ◽

Cited By ~ 1

Author(s):

Shegaze Shimbre Mulugeta ◽

Shibru Degaga Tamiru ◽

Hussen Hebo Sultan ◽

Zerdo Zerihun ◽

Girum Tadele ◽

...

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Multidrug Resistant ◽

Predictors Of Mortality ◽

Resistant Tuberculosis ◽

Multidrug Resistant Tuberculosis ◽

Mdr Tb

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Multidrug-resistant tuberculosis in Lisbon: unfavourable treatment and associated factors, 2000–2014

The International Journal of Tuberculosis and Lung Disease ◽

10.5588/ijtld.18.0596 ◽

2019 ◽

Vol 23 (10) ◽

pp. 1075-1081

Author(s):

M. Bhering ◽

A. Kritski ◽

C. Nunes ◽

R. Duarte

Keyword(s):

Multidrug Resistant ◽

Foreign Born ◽

Loss To Follow Up ◽

Factors Associated ◽

Resistant Tuberculosis ◽

Multidrug Resistant Tuberculosis ◽

Immunodeficiency Virus ◽

Mdr Tb ◽

The City

SETTING: The incidence of tuberculosis (TB) has been decreasing in Portugal. Lisbon concentrates the largest number of cases of multidrug-resistant (MDR) TB in the country. This study aims at identifying clinical and demographic factors associated with unfavourable treatment results of patients with MDR-TB in the city.METHOD: The data on 265 MDR-TB cases, notified from 2000 to 2014 in the District of Lisbon, were collected from the Tuberculosis Surveillance System. Unfavourable cases were classified as failure, loss to follow-up (LTFU) and death. Bivariate and multivariate logistic regressions were undertaken to estimate the factors associated with unfavourable outcomes, LTFU and death.RESULTS: The proportion of unfavourable outcomes was 30.5%. These were associated mostly with being male, foreign-born and resistant to kanamycin. Death was associated with being human immunodeficiency virus-positive and resistant to kanamycin. Being foreign-born had a 4.46-fold higher odds of a LTFU outcome than did being Portuguese-born. The foreign-born patients were mostly African immigrants.CONCLUSION: The main finding in this study is that foreign-born patients are associated with a higher probability of unfavourable outcomes than Portuguese-born patients. Therefore, foreign-born patients need more careful monitoring in the control of MDR-TB.

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