Risk factors for poor treatment outcomes in patients with MDR-TB and XDR-TB in China: retrospective multi-center investigation

Shenjie Tang; Shouyong Tan; Lan Yao; Fujian Li; Li Li; Xinzhi Guo; Yidian Liu; Xiaohui Hao; Yanqiong Li; Xiuxiu Ding; Zhanjun Zhang; Li Tong; Jianan Huang

doi:10.1371/journal.pone.0082943

Risk factors for poor treatment outcomes in patients with MDR-TB and XDR-TB in China: retrospective multi-center investigation

PLoS One. 2013 Dec 5;8(12):e82943. doi: 10.1371/journal.pone.0082943. eCollection 2013.

Authors

Shenjie Tang¹, Shouyong Tan², Lan Yao³, Fujian Li⁴, Li Li⁵, Xinzhi Guo⁶, Yidian Liu³, Xiaohui Hao³, Yanqiong Li², Xiuxiu Ding², Zhanjun Zhang³, Li Tong², Jianan Huang⁷

Affiliations

¹ Department of Respiratory Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China ; Tuberculosis Center for Diagnosis and Treatment, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
² Department of Tuberculosis, Guangzhou Chest Hospital, State Key Laboratory of Respiratory Disease, Guangzhou, China.
³ Tuberculosis Center for Diagnosis and Treatment, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
⁴ Hangzhou Red Cross Hospital, Hangzhou, China.
⁵ Tianjin Haihe Hospital, Tianjin, China.
⁶ Henan Infectious Hospital, Zhengzhou, China.
⁷ Department of Respiratory Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China.

Abstract

Background: The treatment of patients with MDR- and XDR-TB is usually more complex, toxic and costly and less effective than treatment of other forms of TB. However, there is little information available on risk factors for poor outcomes in patients with MDR- and XDR-TB in China.

Methodology/principal findings: We retrospectively analyzed the clinical records of HIV-negative TB Patients with culture-proven MDR- or XDR-TB who were registered from July 2006 to June 2011 at five large-scale Tuberculosis Specialized Hospitals in China. Among 1662 HIV-seronegative TB cases which were culture-positive for M. tuberculosis complex and had positive sputum-smear microscopy results, 965 cases (58.1%) were DR-TB, and 586 cases (35.3%) were classified as having MDR-TB, accounting for 60.7% of DR-TB. 169 cases (10.2%) were XDR-TB, accounting for 17.5% of DR-TB, 28.8% of MDR-TB. The MDR-TB patients were divided into XDR-TB group (n=169) and other MDR-TB group (non-XDR MDR-TB) (n=417). In total, 240 patients (40.95%) had treatment success, and 346 (59.05%) had poor treatment outcomes. The treatment success rate in other MDR-TB group was 52.2%, significantly higher than that in the XDR-TB group (13%, P<0.001). In multivariate logistic regression analysis, poor outcomes were associated with duration of previous anti-TB treatment of more than one year (OR, 0.077; 95% CI, 0.011-0.499, P<0.001), a BMI less than 18.5 kg/m(2) (OR, 2.185; 95% CI, 1.372-3.478, P<0.001), XDR (OR, 13.368; 95% CI, 6.745-26.497, P<0.001), retreatment (OR, 0.171; 95% CI, 0.093-0.314, P<0.001), diabetes (OR, 0.305; 95% CI, 0.140-0.663, P=0.003), tumor (OR, 0.095; 95% CI, 0.011-0.795, P=0.03), decreased albumin (OR, 0.181; 95% CI, 0.118-0.295, P<0.001), cavitation (OR, 0.175; 95% CI, 0.108-0.286, P<0.001).

Conclusions/significance: The patients with MDR-TB and XDR-TB have poor treatment outcomes in China.The presence of extensive drug resistance, low BMI, hypoalbuminemia, comorbidity, cavitary disease and previous anti-TB treatment are independent prognostic factors for poor outcome in patients with MDR-TB.

Publication types

Clinical Trial
Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
China / epidemiology
Humans
Middle Aged
Mycobacterium tuberculosis*
Retrospective Studies
Sputum / microbiology*
Tuberculosis, Multidrug-Resistant / drug therapy
Tuberculosis, Multidrug-Resistant / mortality*

Grants and funding

This study was supported by the Key Project of Chinese National Programs (grant No. 2009ZX10003-017). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.