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Volume 21, Number 6—June 2015
CME ACTIVITY - Research

Acquired Drug Resistance in Mycobacterium tuberculosis and Poor Outcomes among Patients with Multidrug-Resistant Tuberculosis

Russell R. KempkerComments to Author , Maia Kipiani, Veriko Mirtskhulava, Nestani Tukvadze, Matthew J. Magee, and Henry M. Blumberg
Author affiliations: Emory University School of Medicine, Atlanta, Georgia, USA (R.R. Kempker, H.M. Blumberg); National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia (M. Kipiani, N. Tukvadze); Davit Tvildiani Medical University, Tbilisi (V. Mirtskhulava); Georgia State University School of Public Health, Atlanta (M.J. Magee)

Main Article

Table 3

Characteristics of patients with multidrug-resistant tuberculosis, by treatment outcome, Georgia, March 2009–October 2012*

Characteristic Poor outcome, n = 61 Favorable outcome, n = 79 p value†
Acquired resistance to any second-line drug 17 (28) 2 (3) <0.01
Median age, y 39.7 33.7 0.21
Male sex 49 (80) 53 (67) 0.08
History of imprisonment 21 (34) 19 (24) 0.18
Diabetes mellitus 6 (10) 10 (13) 0.60
Hepatitis C 9 (15) 7 (9) 0.28
HIV 3 (5) 3 (4) 0.75
BMI ≤18.5 kg/m2 14 (23) 21 (27) 0.63
History of TB 29 (48) 33 (42) 0.50
Prior TB treatment 0.77
None 32 (53) 46 (58) NA
First-line 24 (39) 28 (35) NA
Second-line 5 (8) 5 (6) NA
Baseline cavitary disease 17 (28) 13 (17) 0.11
Median no. drugs to which baseline isolate was resistant 6 5 0.18
Resistant to ≥6 drugs on baseline DST 32 (53) 28 (35) 0.04
Baseline ofloxacin resistant 6 (10) 3 (4) 0.15
Baseline capreomycin kanamycin resistant 24 (39) 23 (29) 0.20
Starting SLDs >30 days 28 (46) 38 (48) 0.80
Initial MDR TB treatment regimen included
Capreomycin 25 (41) 40 (51) 0.26
Kanamycin 35 (57) 46 (58) 0.92
Ever received
Moxifloxacin 11 (18) 9 (12) 0.27
Clarithromycin 3 (5) 2 (3) 0.45
Augmentin 3 (5) 2 (3) 0.45
Clofazimine 3 (5) 3 (4) 0.75
Treatment interruption 29 (48) 27 (34) 0.11
Adjunctive surgery performed 3 (5) 4 (5) 0.97
Baseline sputum AFB smear value >3+ 23 (38) 23 (29) 0.28
Sputum culture positive, mo‡
2 58 (95) 62 (79) <0.01
4 44 (72) 36 (46) <0.01
6 34 (56) 14 (18) <0.01
Sputum smear positive, mo‡
2 53 (87) 61 (77) 0.14
4 42 (69) 35 (44) <0.01
6 28 (46) 11 (14) <0.01

*BMI, body mass index; TB, tuberculosis; NA, not applicable; DST, drug susceptibility testing; SLDs, second-line drugs; MDR, multidrug resistant; AFB, acid-fast bacilli.
†Comparing persons with and without acquired resistance by using χ2 or Fischer exact tests for categorical variables and t-test or median test for continuous variables.
‡Time from initiation of second-line drug treatment for MDR TB.

Main Article

Page created: May 15, 2015
Page updated: May 15, 2015
Page reviewed: May 15, 2015
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