The Demographic and Clinical Characteristics of Multidrug-resistant Tuberculosis Patients in Taiwan

Abstract

Background: There are approximately 400 multidrug-resistant tuberculosis (MDRTB) patients in Taiwan currently. A new MDR-TB treatment program based on DOTS-plus was started in May, 2007 by the Centers for Disease Control (CDC), Taiwan. The demographics and clinical characteristics of these participants have not been described. To describe the demographics, clinical characteristics and resistance patterns of patients enrolled in the MDR-TB treatment program. Method: The inclusion criteria for the new MDR-TB treatment program include patients who were (1) sputum culture positive after Jan 1, 2007 (2) had Mycobacterium tuberculosis isolate showed isoniazid and rifampin resistance confirmed by the Centers for Research and Diagnostics, Taiwan or other CDC contract laboratories. We collected and analyzed demographics, clinical characteristics, medical history, and isolate drug susceptibility tests of patients enrolled between May and November, 2007. The patients were classified according to WHO guideline. Results: A total of 171 patients were enrolled in the MDRTB program between May and November, 2007. Mean age of the patients was 50.6 years; 137 (80.1%) were men. There were 46 (28.2%) aboriginals, 3 (1.8%) incarcerated, and 3 (1.8%) living in a long term care facility. Forty-one (24.0%) were new patients and 83 (48.5%) had treatment failure or relapse. Exclude the new patients of our MDR program, 25 (19.8%) developed both isoniazid and rifampin resistance within one year of starting anti-tuberculosis treatment, and 81 (64.3%) developed resistance after more than two years of treatment. Drug resistance was highest against fluoroquinolone (49%). Conclusion: Having prior treatment with poor compliance was considered the major determinant of developing MDR-TB. However, 24% of our MDR-TB patients were new patients, indicating possible transmission of MDR-TB in Taiwan. Aggressive TB control efforts are needed to prevent further development and spread of MDR-TB.