Outcomes and follow-up of patients treated for multidrug-resistant tuberculosis in Orel, Russia, 2002-2005

Abstract

Setting: Multidrug-resistant tuberculosis (MDR-TB) treatment facility, Orel Oblast, Russian Federation.

Objectives: To determine factors associated with poor outcome and to document status of patients after recording of TB outcomes.

Design: Retrospective review of prospective single cohort.

Results: Among 192 patients, factors significantly associated with poor outcome in multivariate analysis include three or more treatment interruptions during the intensive phase of therapy and alcohol or drug addiction (adjusted OR [aOR] 2.1, 95%CI 1.0-4.3 and aOR 1.9, 95%CI 1.0-3.7). Previous treatment was associated with poor outcome, but only among smear-positive patients (aOR 3.1, 95%CI 1.3-7.3). Ten patients (5%) developed extensively drug-resistant TB (XDR-TB) during treatment; of 115 patients with at least 6 months of follow-up data after outcomes were recorded, 13 (11%) developed XDR-TB.

Conclusion: Interventions focused on supporting patient adherence during the intensive phase of treatment; the management of drug and alcohol addiction should be developed and studied. A substantial proportion of patients developed XDR-TB during and after treatment. Longer term follow-up data of patients treated for MDR-TB are needed to better inform programmatic policy.

Figure

Drug resistance among patients in whom treatment failed (n = 30). INH = isoniazid; RMP = rifampin; EMB = ethambutol; SM = streptomycin; KM = kanamycin; CPM = capreomycin; OFX = ofloxacin; THI = thioamide; CS = cycloserine.