Recurrence after Successful Treatment of Multidrug-Resistant Tuberculosis in Taiwan

Recurrence after successful treatment for multidrug-resistant tuberculosis (MDR-TB) is challenging because of limited retreatment options. This study aimed to determine rates and predictors of MDR-TB recurrence after successful treatment in Taiwan. Recurrence rates were analyzed by time from treatme...

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Bibliographic Details
Published in:PloS one 2017-01, Vol.12 (1), p.e0170980-e0170980
Main Authors: Chen, Meng-Yu, Lo, Yi-Chun, Chen, Wan-Chin, Wang, Kwei-Feng, Chan, Pei-Chun
Format: Article
Language:English
Subjects:
Adult
Aged
Antibiotics
Antitubercular Agents - therapeutic use
Biology and Life Sciences
Care and treatment
Cavitation
Cavitation resistance
Databases, Factual
Drug resistance
Extensively drug-resistant tuberculosis
Female
Follow-Up Studies
Humans
Laboratories
Lesions
Medical screening
Medicine and Health Sciences
Middle Aged
Multidrug resistance
Multidrug resistant organisms
Mycobacterium
Mycobacterium tuberculosis
Patients
Preventive medicine
Radiography
Radiography, Thoracic
Recurrence
Recurrence (Disease)
Regression analysis
Retrospective Studies
Risk factors
Statistics
Systematic review
Taiwan
Tuberculosis
Tuberculosis, Multidrug-Resistant - diagnostic imaging
Tuberculosis, Multidrug-Resistant - drug therapy
Young Adult
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Summary:Recurrence after successful treatment for multidrug-resistant tuberculosis (MDR-TB) is challenging because of limited retreatment options. This study aimed to determine rates and predictors of MDR-TB recurrence after successful treatment in Taiwan. Recurrence rates were analyzed by time from treatment completion in 295 M DR-TB patients in a national cohort. Factors associated with MDR-TB recurrence were examined using a multivariate Cox regression analysis. Ten (3%) patients experienced MDR-TB recurrence during a median follow-up of 4.8 years. The overall recurrence rate was 0.6 cases per 1000 person-months. Cavitation on chest radiography was an independent predictor of recurrence (adjusted hazard ratio [aHR] = 6.3; 95% CI, 1.2-34). When the analysis was restricted to 215 patients (73%) tested for second-line drug susceptibility, cavitation (aHR = 10.2; 95% CI, 1.2-89) and resistance patterns of extensively drug-resistant TB (XDR-TB) or pre-XDR-TB (aHR = 7.3; 95% CI, 1.2-44) were associated with increased risk of MDR-TB recurrence. In Taiwan, MDR-TB patients with cavitary lesions and resistance patterns of XDR-TB or pre-XDR-TB are at the highest risk of recurrence. These have important implications for MDR-TB programs aiming to optimize post-treatment follow-up and early detection of recurrent MDR-TB.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0170980