Characteristics and treatment outcomes of patients with MDR tuberculosis

Abstract

Introduction: Multidrug-resistant (MDR) tuberculosis is a growing clinical and public-health concern. The treatment of patients with MDR- and XDR-TB is more complex, toxic and costly and less effective than treatment for other forms of TB. A better understanding of risk factors associated with poor treatment outcomes among MDR- and XDR-TB patients would be useful to provide better case management. Objectives: The aim of this study was to determinate the characteristics, treatment outcomes and risk factors associated with poor treatment outcomes among patients who were treated for MDR-TB in intensive phase. Methodology and materials: Retrospective study about all cases of MDR TB of patients hospitalized in the Phthisiopneumology Department of Municipal Hospital, Bălţi, Moldova, between 2009-2010. Fifty patients were enrolled to the trial from June 2009 to August 2010. It was examined the group of patient - saccording tothe distribution of cases by gender affiliation, age, location and living conditions, employment, harmfulhabits, associated diseases, changesin treatment regimens, adverse effects, regimen and the influence of these factors on outcomes of treatment for MDR TB. The statistical analyses of the study results were done based on computer software specialized applications (Microsoft Excel 2007 for Windows). Results: MDR TB is more common in men 84% than in women 16%, the most affected age is 19-49 - 80%, and the urban population is affected in 68% than rural 32%. According to the structure of social categories the damage occurs as follows: unemployed population 74%, the employees 12%, pensioner 4%, students 4%, disabled persons 4% and from the prison - 2%. Associated diseases were represented by chronic toxic hepatitis 30%, cardiovascular failure 8%, viral hepatitis 8%, HIV infection 8%, after surgery 6%, encephalopathy of mixed etiology 6%, gastroduodenal ulcers 4%, and diabetes 2%. Among the studied patients 36% were new case, 64% retreatment. The harmful habits had 80%, the rest 20% were denied them. Among the harmful habits 60% were the use of alcohol, 30% - the use of tobacco, 10% - the use of narcotic substances. The adverse effects were in 54% cases, the rest 46% tolerated well the treatment. The most frequently occurring adverse effects were seizures 20%, insomnia 10%, gastroduodenaldisorders 14%, skinrash anditching each of 12%,arthralgia 10%.The most frequently adverse effects occurred in 50% of consumersof alcohol, 20% in consumers of tobacco, 10% consumers of narcotic substances and 20% in patientswho deny adverse effects. The treatment regimen was complied in 58%, in the rest 42% it wasn’t complied. The irregular treatment was widespread among 60% consumers of alcohol, 20% consumers of narcotics, 14% patients with adverse effects, 6% among others. The causes of noncompliance of treatment were drunkenness 60%, refusal to take drugs l0%, absence from stationary 30%. The treatment time were: under the 6 months 10%, 6 months-68%, more than 6 months - 22%. Outcomes of treatment: 70% AFB -, 26% BK+, 4% deaths. Among BK+ there was 16% treatment failure, 10% abandonment. • Conclusions: Close attention needs to be paid to monitoring patients in order to ensure adherence of treatment, avoiding of harmful habits and to make an adequate changes in treatment when adverse effects occur.