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Multicenter Study
. 2025 Sep 1;25(1):1086.
doi: 10.1186/s12879-025-11491-4.

Treatment outcomes and associated influencing factors among elderly patients with rifampicin-resistant tuberculosis: a multicenter, retrospective, cohort study in China

Huicong Liu #  1 , Liping Zou #  2 , JiaJia Yu #  3 , Qingdong Zhu #  4 , Song Yang #  5 , Wanli Kang  1 , Jiaojie Ma  1 , Qing Chen  2 , Zhengyu Shi  2 , Xianzhen Tang  2 , Li Liang  2 , Peijun Tang  6 , Qing Pan  7 , Chunhui Guo  8 , Juan Du  9 , Zhanlin Chang  10 , Zhouli Guo  2 , Guihui Wu  11 , Shenjie Tang  12
Affiliations
Multicenter Study

Treatment outcomes and associated influencing factors among elderly patients with rifampicin-resistant tuberculosis: a multicenter, retrospective, cohort study in China

Huicong Liu et al. BMC Infect Dis. .

Abstract

Background: Rifampicin-resistant tuberculosis (RR-TB) remains a significant global public health concern. The elderly population is not only at high risk and among the primary victims of RR-TB but also plays a crucial role in the transmission chain of RR-TB. Their biological particularities, treatment complexities, and social vulnerabilities collectively present substantial challenges to global tuberculosis control. This study aimed to evaluate treatment outcomes and identify predictors of unfavorable outcomes among elderly patients with RR-TB in China.

Methods: A multicenter retrospective cohort study was conducted, including 248 elderly RR-TB patients treated across eight tertiary hospitals in China from May 2018 to April 2020. Multivariate logistic regression and Propensity Score Matching (PSM) analyses were performed to identify factors associated with unfavorable outcomes. Statistical analyses were performed using SPSS.

Results: Among 248 patients, 65.7% (163/248) achieved treatment success (cured or completed treatment), while 34.3% (85/248) experienced unfavorable outcomes, including treatment failure (10.5%), death (2.4%), loss to follow-up (15.7%), and non-evaluation (5.6%). Adverse events (AEs) were reported in 56.0% (139/248) of patients, among which anemia was the most common (25.8%). And the use of bedaquiline and linezolid was significantly associated with the occurrence of QT interval prolongation and optic neuritis (p < 0.05). Multivariate analysis revealed that BMI < 18.5 kg/m²(aOR: 3.66, 95% CI: 1.89-7.08, p < 0.01), advanced drug resistance (aOR: 2.25, 95% CI: 1.14-4.45, p = 0.020), pre-treatment anemia (aOR: 4.16, 95% CI: 2.01-8.61, p < 0.001) were independent predictors of unfavorable outcomes. Adjunctive immunotherapy was associated with favorable outcomes (aOR: 0.23, 95% CI: 0.09-0.55, p < 0.001). After PSM, pre-treatment anemia remained significantly correlated with unfavorable outcomes (aOR: 3.5; 95% CI: 1.41-8.67, p = 0.007).

Conclusion: A relatively low rates of treatment success were achieved for RR-TB patients in the elderly at tertiary tuberculosis hospitals in China. Low BMI, advanced drug resistance, and pre-treatment anemia were independent prognostic factors for unfavorable treatment outcomes. Adjunctive immunotherapy was prognostic factors for unfavorable treatment outcomes of elderly RR-TB patients. In tuberculosis management, special consideration should be given to elderly patients.

Keywords: China; Elderly; Rifampicin-resistant TB; Treatment outcomes; Tuberculosis.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study adhered to the tenets of the Declaration of Helsinki and was approved by the Ethics Committee of Public Health Clinical Center of Chengdu as leading center (No.YJ-K2022-81-01). The present study was a retrospective study, the informed consent was waived signed, and all patient data were analyzed anonymously. The need for informed consent was waived by the Ethics Committee of Public Health Clinical Center of Chengdu. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
AEs in 248 elderly RR-TB patients
Fig. 2
Fig. 2
Flow chart for screening eligible studies
See this image and copyright information in PMC

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