Treatment outcomes of patients with multidrug and extensively drug-resistant tuberculosis in Zhejiang, China
Mingwu Zhang, Lin Zhou, Yu Zhang, Bin Chen, Ying Peng, Fei Wang, Zhengwei Liu, Xiaomeng Wang, Songhua Chen
Abstract
BACKGROUND: The aim of this study was to assess the treatment outcomes of multidrug and extensively drug-resistant tuberculosis (M/XDR-TB) in Zhejiang, China and to evaluate possible risk factors associated with poor outcomes of M/XDR-TB. METHODS: Two-hundred-and-sixty-two patients having M/XDR-TB who received the diagnosis and treatment at nine referral hospitals from 1 January 2016 to 31 December 2016 in Zhejiang, China were included. All patients received second-line regimens recommended by WHO under the DOTS-Plus strategy. RESULTS: Among the 262 patients, the treatment success rate was 55.34% (n = 145) with 53.44% (n = 140) cured and 1.91% (n = 5) who completed treatment, 62 (23.66%) failed, 27 (10.31%) died, 16 (6.11%) defaulted and 12 (4.58%) transferred out. Forty (64.52%) of the 62 M/XDR-TB patients who failed treatment were due to adverse effects in the first 10 months of treatment. Eighteen patients (6.37%) had XDR-TB. Treatment failure was significantly higher among patients with XDR-TB at 50% than that among patients with non-XDR-TB at 21.72% (P = 0.006). Failure outcomes were associated with a baseline weight less than 50 kg (OR, 8.668; 95% CI 1.679-44.756; P = 0.010), age older than 60 years (OR, 9.053; 95% CI 1.606-51.027; P = 0.013), hemoptysis (OR, 8.928; 95% CI 1.048-76.923; P = 0.045), presence of cavitary diseases (OR, 10.204; 95% CI 2.032-52.631; P = 0.005), or treatment irregularity (OR, 47.619; 95% CI 5.025-500; P = 0.001). CONCLUSION: Treatment outcomes for M/XDR-TB under the DOTS-Plus strategy in Zhejiang, China were favorable but still not ideal. Low body weight (< 50 kg), old age (> 60 years), severe symptoms of TB including cavitary disease, hemoptysis and irregular treatment were independent prognostic factors for failure outcomes in patients with M/XDR-TB.