Clinical Experience with Multidrug-Resistant Tuberculosis in a TB Referral Hospital

Abstract

Objective: To analyze the outcome and clinical manifestations of patients with multidrug-resistant tuberculosis (MDR- TB) in a regional TB referral center.Methods: From November 1999 through October 2001, all isolates of Mycobacterium tuberculosis with drug resistance were identified via a retrospec-tive review of our mycobacteriolo-gical rereview of our mycobacteriolo-gical records. The medical records of patients with culture proven drug- resistant TB were retrospectively analyzed. MDR-TB was defined as resistance to at least isoniazid and rifampin in vitro. The identification of TB was performed using Mycobacteria growth indicator tube (MGIT) 960 system and drug sensitivity was done by the agar proportional method with a commercial plate.Results: From November 1999 through October 2001, a total of 410 isolates through October 2001, a total of 410 isolates of M. tuberculosis from 408 patients were cultured (408 sputum, 1 pus, 1 pleural effusion). The drug resistance rate of isoniazid was 2.5%, rifampin 10.5%, ethambutol 9%, kanamycin 5.4%, ofloxacin 4.1%, and MDR-TB was 8.3%. The charts of 20 patients with MDR-TB were reviewed. The most common clinical symptoms were cough (85%), dyspnea (70%) and sputum production (65%). The most frequent laboratory findings were most frequent laboratory findings were anemia (45%) and hypoalbuminemia (45%). A mean number of 5 drugs (range 1 to 7) were given for treatment during the course. Culture became negative in 9 patients after a mean of 4.2 months (treatment range 2 to 8). The overall success rate of treatment was 40%. Four patients died. Variables independently associated with an adverse outcomes included the number of drugs to which the TB isolate was resistant (2.9±0.8 v.s. 4.2±1.1, p=0.012) and the number of drugs used for chemotherapy (6.6±0.7 vs 3.4±1.9; p＜0.001). Drug resistant TB was not suspected at initial presentation in 50% of the patients and 3 patients were diagnosed postmortem.Conclusions: Most patients with MDR-TB in this regional referral hospital were inappropriately treated. When appropriate and intensive treatment regimens were used, most patients with MDR-TB can be cured. Hence, if control and eradication of TB is to be achieved, education of patients and doctors in the early recognition and treatment of MDR-TB in this high TB prevalent area is of utmost importance.