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Survival of patients with multidrug-resistant TB in Eastern Europe: what makes a difference?
  1. Yanina Balabanova1,2,3,
  2. Olga Ignatyeva4,
  3. Lena Fiebig3,
  4. Vija Riekstina5,
  5. Manfred Danilovits6,
  6. Kadri Jaama6,
  7. Edita Davidaviciene7,
  8. Birute Radiulyte7,
  9. Christina Marcela Popa8,
  10. Vladyslav Nikolayevskyy1,2,
  11. Francis Drobniewski1,2
  1. 1Blizard Institute, Queen Mary, University of London, London, UK
  2. 2Department of Infectious Diseases, Imperial College London, London, UK
  3. 3Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
  4. 4N.V. Postnikov Samara Region Clinical Tuberculosis Dispensary, Samara, Russia
  5. 5Department of Mycobacteriology, State Agency “Infectology Center of Latvia”, Clinic for Tuberculosis and Lung Diseases, “Upeslejas” Stopinunovads, Riga, Latvia
  6. 6United Laboratory, Department of Mycobacteriology, Tartu University Hospital, Tartu, Estonia
  7. 7National Tuberculosis and Infectious Diseases University Hospital, Vilnius, Lithuania
  8. 8Marius Nasta Institute of Pneumology, Bucharest, Romania
  1. Correspondence to Yanina Balabanova, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin 13353, Germany; LenzY{at}rki.de

Abstract

Background The quality of care for patients with TB in Eastern Europe has improved significantly; nevertheless drug resistance rates remain high. We analysed survival in a cohort of patients with multidrug-resistant and extensively drug-resistant (MDR-/XDR-) TB from Latvia, Lithuania, Estonia and Bucharest city.

Methods Consecutive adult new and retreatment patients with culture-confirmed pulmonary MDR-TB registered for treatment in 2009 (and in 2007 in Latvia) were enrolled; prospective survival information was collected.

Results A total of 737 patients were included into the cohort. Of all MDR-TB cases, 46% were newly diagnosed; 56% of all MDR-TB cases had no additional resistance to fluoroquinolones or injectable agents, 33% had pre-XDR-TB and 11% XDR-TB. Median survival was 5.9 years in patients with MDR-TB and XDR-TB; 1.9 years in patients coinfected with HIV. Older age, male gender, alcohol abuse, retirement, co-morbidities, extrapulmonary involvement and HIV coinfection independently worsened survival. Inclusion of fluoroquinolones and injectable agents improves survival in patients with MDR-TB. Pre-XDR and XDR status did not significantly shorten survival as long as fluoroquinolones and injectable agents were part of the regimen. Moxifloxacin seems to improve survival in ofloxacin-susceptible patients when compared with older generation fluoroquinolones.

Conclusions The burden of additional resistances in patients with MDR-TB is high likely due to primary transmission of resistant strains. Social and programmatic factors including management of alcohol dependency, expansion of HIV testing and antiretroviral treatment need to be addressed in order to achieve cure and to interrupt transmission. The role of last generation fluoroquinolones and injectable agents in treatment of patients with pre-XDR and XDR-TB needs to be further investigated.

  • Tuberculosis

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