Abstract
Treatment of drug-resistant tuberculosis (TB), which is usually less successful than that of drug-susceptible TB, represents a challenge for TB control and elimination. We aimed to evaluate treatment outcomes and to identify the factors associated with death among patients with MDR and XDR-TB in Portugal. We assessed MDR-TB cases reported for the period 2000–2016, using the national TB Surveillance System. Treatment outcomes were defined according to WHO recommendations. We identified the factors associated with death using logistic regression. We evaluated treatment outcomes of 294 MDR- and 142 XDR-TB patients. The treatment success rate was 73.8% among MDR- and 62.7% among XDR-TB patients (p = 0.023). The case-fatality rate was 18.4% among MDR- and 23.9% among XDR-TB patients. HIV infection (OR 4.55; 95% CI 2.31–8.99; p < 0.001) and resistance to one or more second-line injectable drugs (OR 2.73; 95% CI 1.26–5.92; p = 0.011) were independently associated with death among MDR-TB patients. HIV infection, injectable drug use, past imprisonment, comorbidities, and alcohol abuse are conditions that were associated with death early on and during treatment. Early diagnosis of MDR-TB and further monitoring of these patients are necessary to improve treatment outcome.
Highlights
Tuberculosis (TB) treatment success is one indicator for monitoring implementation of the End TB Strategy
We found that pre-XDRSLID-TB patients had worse treatment outcome than patients from other drug-resistance groups: the treatment success rate was 55.6% (p = 0.002) and the casefatality rate was 31.0% (p = 0.065) among them (S1 Table)
This study evaluated treatment outcomes of a cohort of 436 patients with drug-resistant TB diagnosed in Portugal within 17 years, using national TB surveillance data
Summary
Tuberculosis (TB) treatment success (the percentage of cured patients and those with treatment completed) is one indicator for monitoring implementation of the End TB Strategy. The recommended target level for 2025 is above 90% [1]. In the European Union, the treatment success rate for the 45,499 TB cases treated in 2017 was 67.6%, still standing far from the established goal.
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