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. 2017 Aug 16;17(1):573.
doi: 10.1186/s12879-017-2662-8.

Treatment outcomes of patients with multidrug-resistant and extensively drug resistant tuberculosis in Hunan Province, China

Kefyalew Addis Alene  1   2 , Hengzhong Yi  3 , Kerri Viney  4   5 , Emma S McBryde  6 , Kunyun Yang  3 , Liqiong Bai  7 , Darren J Gray  4 , Archie C A Clements  4 , Zuhui Xu  8
Affiliations

Treatment outcomes of patients with multidrug-resistant and extensively drug resistant tuberculosis in Hunan Province, China

Kefyalew Addis Alene et al. BMC Infect Dis. .

Abstract

Background: The worldwide emergence of multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) has posed additional challenges for global tuberculosis (TB) control efforts, as limited treatment options are available and treatment outcomes are often sub-optimal. This study determined treatment outcomes among a cohort of MDR-TB and XDR-TB patients in Hunan Province, China, and identified factors associated with poor treatment outcomes.

Methods: We conducted a retrospective study using data obtained from medical records of TB patients in Hunan Chest Hospital, and from the internet-based TB management information system managed by the Tuberculosis Control Institute of Hunan Province, for the period 2011 to 2014. Treatment outcomes were assessed for patients diagnosed with MDR-TB (TB resistant to at least isoniazid and rifampicin) and XDR-TB (MDR-TB plus resistance to any fluoroquinolone and at least 1 second-line injectable drug). Cumulative incidence functions were used to estimate time to events (i.e. poor treatment outcomes, loss to follow-up, and unfavourable treatment outcomes); and a competing-risks survival regression model was used to identify predictors of treatment outcomes.

Result: Of 481 bacteriologically-confirmed patients, with a mean age of 40 years (standard deviation SD ± 13 years), 10 (2%) had XDR-TB and the remainder (471; 98%) had MDR-TB. For the entire cohort, treatment success was 57% (n = 275); 58% (n = 272) for MDR-TB and 30% (n = 3) for XDR-TB. Overall, 27% were lost to follow-up (n = 130), 27% (n = 126) for MDR-TB and 40% (n = 4) for XDR-TB; and 16% had a poor treatment outcome (n = 76), 15% for MDR-TB and 30% (n = 3) for XDR-TB. Of the 10 XDR-TB patients, 3 (30%) completed treatment, 3 (30%) died and 4 (40%) were lost to follow-up. Of the 471 MDR-TB patients, 258 (57%) were cured, 16 (3%) completed treatment, 13 (3%) died, 60 (13%) experienced treatment failure, and 126 (27%) were lost to follow-up. Resistance to ofloxacin was an independent predictor of poor (AHR = 3.1; 95%CI = 1.5, 6.3), and unfavourable (AHR = 1.7; 95%CI = 1.07, 2.9) treatment outcomes. Patients who started treatment during 2011-2012 (AHR = 2.8; 95% CI = 1.5, 5.3) and 2013 (AHR = 2.1; 95% CI = 1.2, 3.9) had poorer treatment outcomes compared to patients who started treatment during 2014.

Conclusion: Patients with MDR-TB and XDR-TB had low rates of treatment success in Hunan Province, especially among patients who started treatment during 2011 to 2013, with evidence of improved treatment outcomes in 2014. Resistance to ofloxacin was an independent predictor of poor treatment outcomes.

Keywords: China; Extensively drug resistant; Multidrug-resistant; Treatment outcomes; Tuberculosis.

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Conflict of interest statement

Ethics approval and consent to participate

Ethical clearance was obtained from the Australian National University Human Research Ethics Committee (protocol number 2016/218), and Hunan Chest Hospital provided written permission to access the data. As this study used secondary data, informed consent was not obtained from patients.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Cumulative hazard estimate of the probability of a poor treatment outcome (i.e. death or failure) in patients with multidrug-resistant tuberculosis and extensively drug-resistant tuberculosis in Hunan Province, China, 2011–2014
Fig. 2
Fig. 2
Cumulative hazard estimate of the probability of loss to follow-up in patients with multidrug-resistant tuberculosis and extensively drug-resistant tuberculosis in Hunan province, China, 2011–2014
Fig. 3
Fig. 3
Cumulative hazard estimate of the probability of an unfavorable treatment outcome (i.e. death, treatment failure or loss to follow-up) in patients with multidrug-resistant tuberculosis and extensively drug-resistant tuberculosis in Hunan Province, China, 2011–2014
Fig. 4
Fig. 4
Cumulative hazard estimate of the probability of poor treatment outcome (i.e. death or treatment failure) in patients with multidrug-resistant tuberculosis and extensively drug-resistant tuberculosis by year of initiation of treatment in Hunan Province, China, 2011–2014
See this image and copyright information in PMC

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