Predictors of poor outcomes among patients treated for multidrug-resistant tuberculosis at DOTS-plus projects

SummaryThe Objective of this analysis was to identify predictors of death, failure, and default among MDR-TB patients treated with second-line drugs in DOTS-plus projects in Estonia, Latvia, Philippines, Russia, and Peru, 2000–2004.Risk ratios (RR) with 95% confidence intervals (CI) were calculated using multivariable regression.Of 1768 patients, treatment outcomes were: cure/completed – 1156 (65%), died – 200 (11%), default - 241 (14%), failure - 118 (7%). Independent predictors of death included: age>45 years (RR = 1.90 (95%CI 1.29–2.80), HIV infection (RR = 4.22 (2.65–6.72)), extrapulmonary disease (RR = 1.54 (1.04–2.26)), BMI<18.5 (RR = 2.71 (1.91–3.85)), previous use of fluoroquinolones (RR = 1.91 (1.31–2.78)), resistance to any thioamide (RR = 1.59 (1.14–2.22)), baseline positive smear (RR = 2.22 (1.60–3.10)), no culture conversion by 3rd month of treatment (RR = 1.69 (1.19–2.41)); failure: cavitary disease (RR = 1.73 (1.07–2.80)), resistance to any fluoroquinolone (RR = 2.73 (1.71–4.37)) and any thioamide (RR = 1.62 (1.12–2.34)), and no culture conversion by 3rd month (RR = 5.84 (3.02–11.27)); default: unemployment (RR = 1.50 (1.12–2.01)), homelessness (RR = 1.52 (1.00–2.31)), imprisonment (RR = 1.86 (1.42–2.45)), alcohol abuse (RR = 1.60 (1.18–2.16)), and baseline positive smear (RR = 1.35 (1.07–1.71)).Patients with biomedical risk factors for treatment failure or death should receive heightened medical attention. To prevent treatment default, management of patients who are unemployed, homeless, alcoholic, or have a prison history requires extra measures to insure treatment completion.