Published ahead of print on August 14, 2008, doi:10.1164/rccm.200801-132OC Am. J. Respir. Crit. Care Med., Volume 178, Number 10, November 2008, 1075-1082 A more recent version of this article appeared on November 15, 2008
Submitted on January 22, 2008 Treatment Outcomes and Long-term Survival in Patients with Extensively Drug-resistant TuberculosisDoh Hyung Kim1,1 Department of Internal Medicine, Dankook University College of Medicine, Dankook University Hospital, Cheonan, Korea, Republic of, 2 Department of Epidemiology, The Korean Institute of Tuberculosis, Seoul, Korea, Republic of, 3 Clinical Research Center, National Masan Hospital, Masan, Korea, Republic of; Division of Clinical Reserch, International Tuberculosis Research Center, Masan, Korea, Republic of, 4 Department of Thoracic Surgery, Mokpo National Hospital, Mokpo, Korea, Republic of, 5 Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea, Republic of, 6 Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea, Republic of, 7 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Pochon CHA University, Seongnam, Korea, Republic of, 8 Department of Internal Medicine, Chungbuk National University College of Medicine, Chungbuk National University Hospital, Cheongju, Korea, Republic of, 9 Department of Internal Medicine, Inje University School of Medicine, Ilsan Paik Hospital, Goyang, Korea, Republic of, 10 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea, Republic of, 11 Division of HIV and TB Control, Department of Disease Prevention, Korea Centers for Disease Control and Prevention, Seoul, Korea, Republic of, 12 Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea, Republic of; Division of Clinical Reserch, International Tuberculosis Research Center, Masan, Korea, Republic of * To whom correspondence should be addressed. E-mail: shimts{at}amc.seoul.kr.
Rationale: The increasing worldwide incidence of extensively drug-resistant tuberculosis (XDR-TB) has emerged as a threat to public health and TB control. Treatment outcomes have varied among studies, and data on long-term survival are still scarce. Objective: To retrospectively assess the burden, clinical characteristics, treatment outcomes and long-term survival of XDR-TB patients in a cohort of patients with HIV-negative multidrug-resistant tuberculosis (MDR-TB) in South Korea. Methods: Medical records of patients newly diagnosed with or retreated for MDR-TB from 2000 to 2002 were reviewed. The cohort was followed up for 3 to 7 years after treatment initiation. Initial treatment outcomes and cumulative survival were analyzed, and predictors of treatment success and survival were defined. Results: Of 1,407 MDR-TB patients, 75 (5.3%) had XDR-TB at treatment initiation. The default rate was quite high (32.2%, 453/1,407), and XDR-TB had lower treatment success (29.3% vs. 46.2%, P = 0.004) and higher all-cause (49.3% vs. 19.4%, P < 0.001) and TB-related mortality (41.3% vs. 11.8%, P < 0.001) than other MDR-TB. The presence of XDR-TB significantly affected treatment success (OR, 0.23; 95% CI, 0.08-0.64, P = 0.005), all-cause mortality (HR, 3.25; 95% CI, 1.91-5.53, P < 0.001), and TB-related mortality (HR, 4.45; 95% CI, 2.48-8.00, P < 0.001) on multivariate analyses. Conclusion: XDR-TB occurred in a substantial proportion of MDR-TB in South Korea, and was the strongest predictor of treatment outcomes and long-term survival in MDR-TB patients. Adequate TB control policies should be implemented to prevent further development and spread of drug resistance. Key words: Tuberculosis; Tuberculosis, extensively drug-resistant; Survival rate; Treatment efficacy; South Korea
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