J Korean Med Sci.  2011 Jan;26(1):33-41. 10.3346/jkms.2011.26.1.33.

Treatment Outcome and Mortality among Patients with Multidrug-resistant Tuberculosis in Tuberculosis Hospitals of the Public Sector

• Jeon DS
• Shin DO
• Park SK
• Seo JE
• Seo HS
• Cho YS
• Lee JY
• Kim DY
• Kong SJ
• Kim YS
• Shim TS

• KMID: 1777973
• DOI: http://doi.org/10.3346/jkms.2011.26.1.33

Abstract

This study was conducted to evaluate treatment outcome, mortality, and predictors of both in patients with multidrug-resistant tuberculosis (MDR-TB) at 3 TB referral hospitals in the public sector of Korea. We included MDR-TB patients treated at 3 TB referral hospitals in 2004 and reviewed retrospectively their medical records and mortality data. Of 202 MDR-TB patients, 75 (37.1%) had treatment success and 127 (62.9%) poor outcomes. Default rate was high (37.1%, 75/202), comprising 59.1% of poor outcomes. Male sex (adjusted odds ratio [aOR], 2.91; 95% confidence interval [CI], 1.13-7.49), positive smear at treatment initiation (aOR, 5.50; 95% CI, 1.22-24.90), and extensively drug-resistant TB (aOR, 10.72; 95% CI, 1.23-93.64) were independent predictors of poor outcome. The all-cause mortality rate was 31.2% (63/202) during the 3-4 yr after treatment initiation. In conclusion, the treatment outcomes of patients with MDR-TB at the 3 TB hospitals are poor, which may reflect the current status of MDR-TB in the public sector of Korea. A more comprehensive program against MDR-TB needs to be integrated into the National Tuberculosis Program of Korea.

Keyword

Tuberculosis, Multidrug-Resistant; Extensively Drug-Resistant Tuberculosis; Treatment Outcome; Mortality

MeSH Terms

Adolescent
Adult
Aged
Aged, 80 and over
Antitubercular Agents/*therapeutic use
Demography
Drug Resistance, Multiple, Bacterial
Drug Therapy, Combination
Female
Hospitals, Chronic Disease
Humans
Male
Middle Aged
Odds Ratio
Predictive Value of Tests
Retrospective Studies
Sex Factors
Treatment Outcome
Tuberculosis, Multidrug-Resistant/drug therapy/*mortality

Figure

• 

  Fig. 1 Baseline drug resistance among 202 patients with multidrug-resistant tuberculosis. INH, isoniazid; RFP, rifampicin; EMB, ethambutol; PZA, pyrazinamide; SM, streptomycin; KM, kanamycin; OFX, ofloxacin; PAS, para-aminosalicylic acid; PTH, prothionamide; CS, cycloserine.

• 

  Fig. 2 Kaplan-Meier estimates of survival for 202 patients with multidrug-resistant tuberculosis: (A) all-cause mortality according to previous treatment history (P = 0.032 for a vs b, P = < 0.001 for a vs c, P = 0.003 for b vs c, respectively) and (B) all-cause mortality between XDR-TB and non-XDR-TB (P = 0.002). XDR-TB, extensively drug-resistant tuberculosis.

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