Treatment outcomes of drug-resistant tuberculosis in the Netherlands, 2005–2015

Antimicrobial Resistance and Infection Control

Natasha van’t Boveneind-Vrubleuskaya¹  Jan-Willem C. Alffenaar¹  Onno W. Akkerman²  Eelko Hak³  Ivan S. Pradipta³ 

[1] Department of Clinical Pharmacy and Pharmacology, University Medical Centrum Groningen;Department of Pulmonary Diseases and Tuberculosis, University Medical Centre Groningen, University of Groningen;Groningen Research Institute of Pharmacy, Unit of Pharmaco-Therapy, - Epidemiology & - Economics (PTE2), University of Groningen;

关键词: Tuberculosis;    Risk factors;    Predictors;    Unsuccessful treatment;    Mortality;    Epidemiology;   

DOI  :  10.1186/s13756-019-0561-z

来源: DOAJ

【 摘 要 】

Abstract Background Since in low incidence TB countries population migration and complex treatment of drug-resistant tuberculosis (DR-TB) patients are major issues, we aimed to analyse patient risk factors associated with the incidence of poor outcome of TB treatment among DR-TB patients in the Netherlands. Methods This retrospective cohort study included adult patients with confirmed DR-TB treated from 2005 to 2015. We obtained data from a nationwide exhaustive registry of tuberculosis patients in the Netherlands. Predictors for unsuccessful TB treatment (defaulted and failed treatment) and TB-associated mortality were analysed using multivariate logistic regression. Results Among 10,303 registered TB patients, 545 patients with DR-TB were analysed. Six types of DR-TB were identified from the included patients, i.e. isoniazid mono- or poly-resistance (68%); rifampicin mono- or poly-resistance (3.1%); pyrazinamide mono-resistance (8.3%); ethambutol mono-resistance (0.1%); multidrug-resistance (18.9%); and extensively drug-resistance (0.7%). The majority of patients were foreign-born (86%) and newly diagnosed TB (89%) patients. The cumulative incidence of unsuccessful treatment and mortality were 5 and 1%, respectively. Among all DR-TB cases, patients with Multi Drug-Resistant Tuberculosis (MDR-TB) (OR 4.43; 95%CI 1.70–11.60) were more likely to have unsuccessful treatment, while miliary and central nervous system TB (OR 15.60; 95%CI 2.18–111.52) may also be predictors for TB mortality. Additionally, patients with substance abuse and homelessness tend to have unsuccessful treatment. Conclusions In recent years, we identified a low incidence of DR-TB as well as the poor outcome of DR-TB treatment. The majority of cases were primary drug-resistant and foreign-born. To further improve treatment outcome, special attention should be given to the high-risk DR-TB patients.

【 授权许可】

Unknown