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. 2019 Mar 29;6(4):ofz152.
doi: 10.1093/ofid/ofz152. eCollection 2019 Apr.

Long-term Follow-up Reveals High Posttreatment Mortality Rate Among Patients With Extensively Drug-Resistant Tuberculosis in the Country of Georgia

Melanie Frank  1 , Natalia Adamashvili  2 , Nino Lomtadze  2 , Eka Kokhreidze  2 , Zaza Avaliani  2 , Russell R Kempker  3 , Henry M Blumberg  3
Affiliations

Long-term Follow-up Reveals High Posttreatment Mortality Rate Among Patients With Extensively Drug-Resistant Tuberculosis in the Country of Georgia

Melanie Frank et al. Open Forum Infect Dis. .

Abstract

Background: Given very limited data, we assessed the long-term outcomes among patients with extensively drug-resistant (XDR) tuberculosis (TB).

Methods: A retrospective population-based cohort study was performed in patients with XDR-TB diagnosed during 2011-2013 in the country of Georgia. Data were abstracted from the National TB Program, medical charts, interviews, and the national Georgian death registry.

Results: Among 111 patients starting treatment for XDR-TB, 59 (53.2%) had newly diagnosed tuberculosis, and 3 (2.9%) had human immunodeficiency virus (HIV) coinfection. The median length of follow-up from diagnosis of XDR-TB to death or the end of study was 53.9 months (interquartile range, 27.2-66.3 months). End-of-treatment outcomes were available for 106 patients; 35 (33.0%) had a favorable outcome, and 71 (67.0%) had an unfavorable outcome, including death in 16 (15.1%). An additional 20 patients died after cessation of initial treatment, increasing the overall mortality rate to 34.0%. In multivariable analysis, an unfavorable initial end-of-treatment outcome was associated with posttreatment death (adjusted odds ratio, 14.41; 95% confidence interval, 1.78-117.13).

Conclusions: The overall mortality rate and specifically the posttreatment mortality rate were high among patients with XDR-TB. Patients with an unfavorable end-of-treatment outcome had an increased risk of death during follow-up. Our findings highlight the need for improved adherence, better-tolerated and shorter therapies, and enhanced posttreatment surveillance among patients treated for XDR-TB.

Keywords: extensively drug-resistant tuberculosis (XDR-TB); former soviet Republic; posttreatment mortality.

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Figures

Figure 1.
Figure 1.
Flowchart of end-of-treatment and long-term outcomes among patients with extensively drug-resistant (XDR) tuberculosis. Among 21 patients lost to follow-up (LFU) who were alive at end of the study period and did not reenter care, the median (interquartile range [IQR]) duration of initial treatment was 9.8 (5.4–14.6) months. The median (IQR) duration of initial treatment for 13 LFU patients who died during the study period was 5.3 (2.7–7.2) months; 5 of 13 deaths among patients LFU occurred after reentry to care, as did 4 of 6 deaths among patients with treatment failure.
Figure 2.
Figure 2.
Long-term survival among patients with extensively drug-resistant tuberculosis stratified by favorable versus unfavorable initial end-of-treatment outcome. (Log-rank P < .001.)
See this image and copyright information in PMC

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