Abstract
Recurrence after successful treatment for multidrug-resistant tuberculosis (MDR-TB) is challenging because of limited retreatment options. This study aimed to determine rates and predictors of MDR-TB recurrence after successful treatment in Taiwan. Recurrence rates were analyzed by time from treatment completion in 295 M DR-TB patients in a national cohort. Factors associated with MDR-TB recurrence were examined using a multivariate Cox regression analysis. Ten (3%) patients experienced MDR-TB recurrence during a median follow-up of 4.8 years. The overall recurrence rate was 0.6 cases per 1000 person-months. Cavitation on chest radiography was an independent predictor of recurrence (adjusted hazard ratio [aHR] = 6.3; 95% CI, 1.2–34). When the analysis was restricted to 215 patients (73%) tested for second-line drug susceptibility, cavitation (aHR = 10.2; 95% CI, 1.2–89) and resistance patterns of extensively drug-resistant TB (XDR-TB) or pre-XDR-TB (aHR = 7.3; 95% CI, 1.2–44) were associated with increased risk of MDR-TB recurrence. In Taiwan, MDR-TB patients with cavitary lesions and resistance patterns of XDR-TB or pre-XDR-TB are at the highest risk of recurrence. These have important implications for MDR-TB programs aiming to optimize post-treatment follow-up and early detection of recurrent MDR-TB.
Highlights
Multidrug-resistant tuberculosis (MDR-TB), defined as tuberculosis caused by a strain of Mycobacterium tuberculosis resistant to at least isoniazid and rifampin, remains a global concern
As drug resistance patterns have been previously linked to treatment outcomes of multidrug-resistant tuberculosis (MDR-TB) [24], we enrolled patients who had undergone second-line Drug susceptibility testing (DST) in a subgroup analysis to assess its impact on recurrence
There were 375 MDR-TB patients registered at the Taiwan MDR-TB Consortium (TMTC) between May 2007 and December 2010, of whom 295 achieved treatment success (249 were cured, and 46 completed treatment) (Fig 1)
Summary
Multidrug-resistant tuberculosis (MDR-TB), defined as tuberculosis caused by a strain of Mycobacterium tuberculosis resistant to at least isoniazid and rifampin, remains a global concern. In Taiwan, a national program for MDR-TB organized according to the World Health Organization (WHO) guidelines [16,17], named Taiwan MDR-TB Consortium (TMTC), was PLOS ONE | DOI:10.1371/journal.pone.0170980 January 26, 2017
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
