Highly successful treatment outcome of multidrug-resistant tuberculosis in the Netherlands, 2000-2009

• Published in: The international journal of tuberculosis and lung disease 2015-04, Vol.19 (4), p.406-412
• Main Authors: van Altena, R., de Vries, G., Haar, C. H., de Lange, W. C. M., Magis-Escurra, C., van den Hof, S., van Soolingen, D., Boeree, M. J., van der Werf, T. S.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age Distribution; Antitubercular Agents - therapeutic use; Child; Child, Preschool; Coinfection - therapy; Drug Susceptibility Testing; Drug Therapy, Combination; Female; Follow-Up Studies; HIV; HIV Infections - therapy; Humans; Infant; Infant, Newborn; Male; Mdr-Tb; Middle Aged; Mycobacterium; Mycobacterium tuberculosis - drug effects; Netherlands - epidemiology; Outcome; Public Health; Retrospective Studies; Risk Factors; Sex Distribution; Therapeutic Drug Monitoring; Treatment Outcome; Tuberculosis, Multidrug-Resistant - epidemiology; Tuberculosis, Multidrug-Resistant - therapy; Tuberculosis, Pulmonary - therapy; Young Adult
• ISSN: 1027-3719; 1815-7920
• DOI: 10.5588/ijtld.14.0838

SETTING: Resistance to the two key anti-tuberculosis drugs isoniazid and rifampicin is a characteristic of multidrug-resistant tuberculosis (MDR-TB). MDR-TB is a scourge requiring toxic, prolonged treatment and is associated with poor outcomes. The Netherlands is a country with a long-standing, integrated, well-resourced TB service where all patients are offered culture-confirmed diagnosis by a central reference laboratory.OBJECTIVE: To assess the treatment outcomes of MDR-TB patients over a period of 10 years in The Netherlands.DESIGN: Demographic, clinical and microbiological features of all patients with MDR-TB who started treatment in 2000-2009 in the Netherlands were analysed from national registry and patient records.RESULTS: Characteristics of the 113 MDR-TB patients were as follows: male/female ratio 1.57, 96% foreign born, median age 29 years, 96 (85%) pulmonary TB, 56 (50%) smear-positive, 14 (12%) human immunodeficiency virus (HIV) co-infected. Of the 104 (92%) patients who started MDR-TB treatment, 86% had a successful outcome using a median of six active drugs; eight underwent pulmonary surgery. HIV negativity was associated with successful outcome (adjusted OR 2.1, 95%CI 1.1-3.8).CONCLUSION: High success rates for MDR-TB treatment were achieved with close collaboration of all stakeholders, reaching the targets set for drug-susceptible TB. HIV remained an independent risk factor for unsuccessful treatment outcome.