TY - JOUR
T1 - Predictors and outcome of multidrug-resistant tuberculosis
AU - Salomon, Nadim
AU - Perlman, David C.
AU - Friedmann, Patricia
AU - Buchstein, Sara
AU - Kreiswirth, Barry N.
AU - Mildvan, Donna
N1 - Funding Information:
Received 9 February 1995; revised 11 May 1995. This work was presented in part at the 32nd Infectious Diseases Society of America Conference held in October 1994 in Orlando, Florida, and at the 2nd National Conference on Human Retroviruses and Related Infections held in January 1995 in Washington, D.C. The human experimentation guidelines of the U. S. Department of Health and Human Services and those of the authors' institutions were followed in the conduct of the clinical research. Financial support: This work was supported in part by the New York State Department of Health (C-011208) and the Nell and Herbert Singer Research Grant Fund of Beth Israel Medical Center. Reprints or correspondence: Dr. Nadim Salomon, Division of Infectious Diseases, Beth Israel Medical Center, First Avenue at 16th Street, New York, New York 10003.
PY - 1995/11
Y1 - 1995/11
N2 - We identify early predictors of multidrug-resistant tuberculosis and describe improved clinical outcomes, including survival, for patients with human immunodeficiency virus (HIV)#x2013;related multidrug-resistant tuberculosis (MDR-TB) when they are prospectively identified and receive treatment under direct observation. Analysis by means of a Cox proportional hazards model revealed that failure to defervesce while receiving a standard four-drug antituberculous regimen was independently associated with multidrug resistance (P =.004). When patients with HIV-related MDR-TB were prospectively identified and treated with at least two agents that were active in vitro, 100#x0025; bacteriologic conversion and improved survival (#x2264;4 months for 88#x0025; of patients and #x2264;1 year for 59#x0025; of patients) were observed. For patients with HIV-related tuberculosis, poorer survival was associated with a CD4#x002B; lymphocyte count of <25 mm3 (P =.03); multidrug resistance was not a predictor of poor outcome (P =.82). These data suggest that patients with prolonged fever who are receiving antituberculous therapy may be an appropriate subgroup to target for broader empirical therapy. The findings also demonstrate that improved outcomes can be achieved with HIV-related MDR-TB when patients are prospectively identified and treated with agents that are active in vitro.
AB - We identify early predictors of multidrug-resistant tuberculosis and describe improved clinical outcomes, including survival, for patients with human immunodeficiency virus (HIV)#x2013;related multidrug-resistant tuberculosis (MDR-TB) when they are prospectively identified and receive treatment under direct observation. Analysis by means of a Cox proportional hazards model revealed that failure to defervesce while receiving a standard four-drug antituberculous regimen was independently associated with multidrug resistance (P =.004). When patients with HIV-related MDR-TB were prospectively identified and treated with at least two agents that were active in vitro, 100#x0025; bacteriologic conversion and improved survival (#x2264;4 months for 88#x0025; of patients and #x2264;1 year for 59#x0025; of patients) were observed. For patients with HIV-related tuberculosis, poorer survival was associated with a CD4#x002B; lymphocyte count of <25 mm3 (P =.03); multidrug resistance was not a predictor of poor outcome (P =.82). These data suggest that patients with prolonged fever who are receiving antituberculous therapy may be an appropriate subgroup to target for broader empirical therapy. The findings also demonstrate that improved outcomes can be achieved with HIV-related MDR-TB when patients are prospectively identified and treated with agents that are active in vitro.
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U2 - 10.1093/clinids/21.5.1245
DO - 10.1093/clinids/21.5.1245
M3 - Article
C2 - 8589150
AN - SCOPUS:85047698598
SN - 1058-4838
VL - 21
SP - 1245
EP - 1252
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 5
ER -