Adjunctive surgery improves treatment outcomes among patients with multidrug-resistant and extensively drug-resistant tuberculosis

• Type of Material: Article
• Authors: Medea Gegia, The National Center for Tuberculosis and Lung Diseases and Georgian National TB Program; Iagor Kalandadze, The National Center for Tuberculosis and Lung Diseases and Georgian National TB Program; Russell Ryan Kempker, Emory University; Matthew James Magee, Emory University; Henry Michael Blumberg, Emory University
• Language: English
• Date: 2012-05-01
• Publisher: Elsevier: Creative Commons Attribution Non-Commercial No-Derivatives License
• Publication Version: Final Published Version
• Copyright Statement: © 2012 International Society for Infectious Diseases.
• Final Published Version (URL): http://dx.doi.org/10.1016/j.ijid.2011.12.018
• Title of Journal or Parent Work: International Journal of Infectious Diseases
• ISSN: 1201-9712
• Volume: 16
• Issue: 5
• Start Page: E391
• End Page: E396
• Grant/Funding Information: This study was supported in part by a grant from the US National Institutes of Health (NIH) Fogarty International Center (D43TW007124 and D43TW007124-06S1).
• Keywords: FOLLOW-UP; Surgery; PREDICTORS; Outcome; Infectious Diseases; SURVIVAL; Treatment; RISK-FACTORS; Drug-resistant; Tuberculosis; Life Sciences & Biomedicine; Science & Technology
• Research Categories: Health Sciences, General; Health Sciences, Immunology

Abstract

Objectives: To determine risk factors for poor outcomes among patients with pulmonary multidrug- or extensively drug-resistant (M/XDR) tuberculosis (TB) in Georgia. Methods: This was a prospective, population-based observational cohort study. Results: Among 380M/XDR-TB patients (mean age 38 years), 179 (47%) had a poor outcome: 59 (16%) died, 37 (10%) failed, and 83 (22%) defaulted. Newly diagnosed M/XDR-TB cases were significantly more likely to have a favorable outcome than retreatment cases (odds ratio (OR) 4.26, 95% confidence interval (CI) 1.99-9.10, p<0.001). In the multivariable analysis, independent risk factors for a poor treatment outcome included previous treatment history (OR 2.92, 95% CI 1.29-6.58), bilateral disease (OR 1.90, 95% CI 1.20-3.01), body mass index (BMI, kg/m2) ≤18.5 (OR 1.91, 95% CI 1.11-3.29), and XDR-TB (OR 2.28, 95% CI 1.11-4.71). Patients who underwent surgical resection (OR 0.27, 95% CI 0.11-0.64) and had sputum culture conversion by 4 months (OR 0.33, 95% CI 0.21-0.52) were significantly less likely to have poor treatment outcomes. Conclusions: Adjunctive surgery appeared to be beneficial in treating patients with M/XDR-TB. Retreatment cases, XDR-TB, bilateral disease, and low BMI were associated with a poor outcome. Additional studies are needed to further define the apparent beneficial role of surgery in the treatment of M/XDR-TB.