Survival of patients with multidrug-resistant TB in Eastern Europe: what makes a difference?
In: Thorax, Jg. 71 (2016-09-01), Heft 9, S. 854-861
Online
academicJournal
Zugriff:
Background: The quality of care for patients with TB in Eastern Europe has improved significantly; nevertheless drug resistance rates remain high. We analysed survival in a cohort of patients with multidrug-resistant and extensively drug-resistant (MDR-/XDR-) TB from Latvia, Lithuania, Estonia and Bucharest city. Methods: Consecutive adult new and retreatment patients with culture-confirmed pulmonary MDR-TB registered for treatment in 2009 (and in 2007 in Latvia) were enrolled; prospective survival information was collected. Results: A total of 737 patients were included into the cohort. Of all MDR-TB cases, 46% were newly diagnosed; 56% of all MDR-TB cases had no additional resistance to fluoroquinolones or injectable agents, 33% had pre-XDR-TB and 11% XDR-TB. Median survival was 5.9 years in patients with MDR-TB and XDR-TB; 1.9 years in patients coinfected with HIV. Older age, male gender, alcohol abuse, retirement, co-morbidities, extrapulmonary involvement and HIV coinfection independently worsened survival. Inclusion of fluoroquinolones and injectable agents improves survival in patients with MDR-TB. Pre-XDR and XDR status did not significantly shorten survival as long as fluoroquinolones and injectable agents were part of the regimen. Moxifloxacin seems to improve survival in ofloxacin-susceptible patients when compared with older generation fluoroquinolones. Conclusions: The burden of additional resistances in patients with MDR-TB is high likely due to primary transmission of resistant strains. Social and programmatic factors including management of alcohol dependency, expansion of HIV testing and antiretroviral treatment need to be addressed in order to achieve cure and to interrupt transmission. The role of last generation fluoroquinolones and injectable agents in treatment of patients with pre-XDR and XDR-TB needs to be further investigated. [ABSTRACT FROM AUTHOR]
Copyright of Thorax is the property of BMJ Publishing Group and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Titel: |
Survival of patients with multidrug-resistant TB in Eastern Europe: what makes a difference?
|
---|---|
Autor/in / Beteiligte Person: | Balabanova, Yanina ; Ignatyeva, Olga ; Fiebig, Lena ; Riekstina, Vija ; Danilovits, Manfred ; Jaama, Kadri ; Davidaviciene, Edita ; Radiulyte, Birute ; Popa, Christina Marcela ; Nikolayevskyy, Vladyslav ; Drobniewski, Francis |
Link: | |
Zeitschrift: | Thorax, Jg. 71 (2016-09-01), Heft 9, S. 854-861 |
Veröffentlichung: | 2016 |
Medientyp: | academicJournal |
ISSN: | 0040-6376 (print) |
DOI: | 10.1136/thoraxjnl-2015-207638 |
Schlagwort: |
|
Sonstiges: |
|