Treatment outcomes of multiple and extensive drug resistant tuberculosis and efficiency of surgical resections in patients with high risk of unfavorable outcomes
https://doi.org/10.21292/2075-1230-2016-94-5-28-34
Abstract
The retrospective cohort study was aimed to evaluate treatment outcomes of 476 patients suffering from multiple and extensive drug resistance, to detect risk factors of unfavorable outcomes and to assess the impact of surgical resections on treatment outcomes. 71.8% of patients were cured, in 22.7% treatment failed, and 5.5% died during treatment. Main predictors of the unfavorable outcome were destructive changes in the lungs (Odds ratio (OR) 10.0; 95% CI 2.4-41.9), more than 2 segments of the lungs affected by tuberculosis (OR 6.8; 95%- CI 3.9-11.9), positive results of sputum smear microscopy (OR 3.1; 95% CI 2.0-4.9), pre-XDR of M. tuberculosis (OR 1.9; 95% CI 1.3-2.9), concurrent HIV infection (OR 3.3; 95% CI 1.3-8.2), addiction to alcohol and/or substances (OR 4.8; 95% CI 3.1-7.5), treatment interruption (OR 7.3; 95% CI 4.6-11.8), prescription of non-standard chemotherapy regimens (OR 2.2; 95% CI 1.4-3.4), low income (OR 3.4; 95% CI 2.1-5.5), incarceration (OR 2.2; 95% CI 1.3-3.6). Regarding statistical significance the use of surgical resections was related to the reduction of the risk of unfavorable outcomes also among the patients with treatment failure predictors.
About the Authors
Ya. R. Batyrshina
Novosibirsk Tuberculosis Research Institute
Russian Federation
Russian Federation
Bacterilogist,
81a, Okhotskaya St., Novosibirsk, 630040
V. A. Krasnov
Novosibirsk Tuberculosis Research Institute
Russian Federation
Russian Federation
Director,
81a, Okhotskaya St., Novosibirsk, 630040
T. I. Petrenko
Novosibirsk Tuberculosis Research Institute
Russian Federation
Russian Federation
Deputy Director for Research,
81a, Okhotskaya St., Novosibirsk, 630040
References
1. Natsionalnye klinicheskie rekomendatsii po primeneniyu khirurgicheskikh metodov v lechenii tuberkuleza legkikh. Natsionalnaya assotsiatsiya ftiziatrov. Аssotsiatsiya torakalnykh khirurgov Rossii. [National clinical guidelines for surgical treatment of pulmonary tuberculosis. National Association of TB Doctors. Association of Thoracic Surgeons of Russia]. 2013. http://nasph.ru/index/klinicheskie_rekomendacii/0-30
2. Osnovnye pokazateli protivotuberkuleznoy deyatelnosti v Sibirskom i Dalnevostochnom federalnykh okrugakh. [Main rates of anti-tuberculosis activities in Siberian and Far Eastern Federal Districts]. Novosibirsk Tuberculosis Research Institute, Russian Ministry of Health Publ., Collection of Tables, Novosibirsk, 2013, 89 p.
3. Strelis A.K. et al. Efficiency of surgical treatment of multiple drug resistant pulmonary tuberculosis within DOTS Plus Programme. Bulleten’ Sibirskoy Meditsiny, 2009, no. 1, pp. 85-93. (In Russ.)
4. Federal Service of State Statistics. http://www.gks.ru/wps/wcm/connect/rosstat_main/rosstat/ru/statistics/population/healthcare
5. Shilova M.V. Tuberkulez v Rossii v 1999 g. [Tuberculosis in Russia in 1999]. Moscow, 2000, 48 p.
6. Shilova M.V. Tuberkulez v Rossii v 2012-2013 godu. [Tuberculosis in Russia in 2012-2013]. Moscow, 2014, 244 p.
7. Canetti G. The J. Burns Amberson lecture. Present aspects of bacterial resistance in tuberculosis. Am. Rev. Respir. Dis., 1965, vol. 92, pp. 687-703.
8. Harbour R., Miller J.A new system for grading recommendation in evidence based guidelines. BMJ, 2001, vol. 323, pp. 334 336.
9. Kang M.W. et al. Surgical treatment for multidrug-resistant and extensive drug-resistant tuberculosis. Ann. Thoracic Surgery, 2010, vol. 89, no. 5, pp. 1597-1602.
10. Kir A. et al. Adjuvant resectional surgery improves cure rates in multidrug-resistant tuberculosis. J. Thorac.Cardiovas. Surgery, 2006, vol. 131, no. 3, pp. 693-696.
11. Kwon Y.S., Kim Y.H., Suh G.Y. et al. Treatment outcomes for HIV-uninfected patients with multidrug-resistant and extensively drug-resistant tuberculosis. Clin. Infect. Diseases, 2008, vol. 47, no. 4, pp. 496-502.
12. Marrone M.T., Venkataramanan V., Goodman M. et al. Surgical interventions for drug-resistant tuberculosis: a systematic review and meta-analysis. Int. J. Tuberc. Lung Dis., 2013, vol. 17, no. 1, pp. 6-16.
13. World Health Organization. Global Tuberculosis Report 2014. WHO/HTM/TB/2014.08 / Geneva, 2014. 118 p.
14. World Health Organization. Guidelines for theprogrammatic management of drug-resistant tuberculosis. WHO/HTM/TB/2008.402 / Geneva, 2008. 247 p.
15. World Health Organization. The role of surgery in the treatment of pulmonary TB and multidrug- andextensively drug-resistant TB/ Geneva, 2014. 23 p.
Review
For citations:
Batyrshina Ya.R., Krasnov V.A., Petrenko T.I. Treatment outcomes of multiple and extensive drug resistant tuberculosis and efficiency of surgical resections in patients with high risk of unfavorable outcomes. Tuberculosis and Lung Diseases. 2016;94(5):28-34. (In Russ.) https://doi.org/10.21292/2075-1230-2016-94-5-28-34
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