Introduction and objectives Multi-drug resistant tuberculosis (MDR-TB), defined as TB resistant to rifampicin and isoniazid is an expanding problem. 1.6% of TB isolates in the UK are MDR-TB, but rates are higher in some parts of the world. Treatment is usually 20–24 months and frequently associated with significant side effects. In our city, MDR-TB is mostly managed in two main hospitals. We sought to examine the characteristics and outcomes of our MDR-TB patients. Methods
Patients from 1st Jan 2008 from one institution and 1st Jan 2009 from the other institution were included with a cutoff period of 1st May 2013 and follow up to 1st June 2013. Data was gathered from case note review and enhanced tuberculosis surveillance data.
Results 31 patients were identified; demographics are shown in table 1. Site of TB was pulmonary in 18(58%) patients, lymph node in 10(32%), soft tissue in 2(6%), and intra-cerebral in 1(3%). 10(32%) patients were on standard anti TB treatment at time of diagnosis. 22(71%) patients developed side effects of treatment; these included ototoxicity (7 patients), gastrointestinal side effects (4 patients), hypothyroidism due to para-aminosalicylic acid or prothionamide (2 patients) and neuropsychiatric side effects from cycloserine (2 patients). 9(29%) patients underwent a surgical procedure; 7 for diagnosis and 2 to assist treatment (both lobectomies). Treatment was ongoing in 14(45%) patients and 11(35%) patients had completed treatment by the cutoff period. 4(12%) patients defaulted and 2 patients were transferred out during treatment (1 overseas, 1 to another UK centre).
Conclusions The lack of MDR-TB risk factors in a proportion of patients underscores the importance of trying to obtain microbiological samples and utilisation of resistance mutation analysis. Side effects are frequent and treatment should be undertaken by physicians with expertise. The BTS MDR-TB service plays a valuable role in management of these complex patients.