Predictors and outcome of multidrug-resistant tuberculosis

Nadim Salomon, David C. Perlman, Patricia Friedmann, Sara Buchstein, Barry N. Kreiswirth, Donna Mildvan

Research output: Contribution to journalArticle

95 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1245-1252
Number of pages8
JournalClinical Infectious Diseases
Volume21
Issue number5
DOIs
StatePublished - Jan 1 1995
Externally publishedYes

Fingerprint

Multidrug-Resistant Tuberculosis
HIV
Multiple Drug Resistance
Survival
CD4 Lymphocyte Count
Proportional Hazards Models
Tuberculosis
Fever
Therapeutics
Observation
Pharmaceutical Preparations

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Salomon, N., Perlman, D. C., Friedmann, P., Buchstein, S., Kreiswirth, B. N., & Mildvan, D. (1995). Predictors and outcome of multidrug-resistant tuberculosis. Clinical Infectious Diseases, 21(5), 1245-1252. https://doi.org/10.1093/clinids/21.5.1245

Predictors and outcome of multidrug-resistant tuberculosis. / Salomon, Nadim; Perlman, David C.; Friedmann, Patricia; Buchstein, Sara; Kreiswirth, Barry N.; Mildvan, Donna.

In: Clinical Infectious Diseases, Vol. 21, No. 5, 01.01.1995, p. 1245-1252.

Research output: Contribution to journalArticle

Salomon, N, Perlman, DC, Friedmann, P, Buchstein, S, Kreiswirth, BN & Mildvan, D 1995, 'Predictors and outcome of multidrug-resistant tuberculosis', Clinical Infectious Diseases, vol. 21, no. 5, pp. 1245-1252. https://doi.org/10.1093/clinids/21.5.1245
Salomon N, Perlman DC, Friedmann P, Buchstein S, Kreiswirth BN, Mildvan D. Predictors and outcome of multidrug-resistant tuberculosis. Clinical Infectious Diseases. 1995 Jan 1;21(5):1245-1252. https://doi.org/10.1093/clinids/21.5.1245
Salomon, Nadim ; Perlman, David C. ; Friedmann, Patricia ; Buchstein, Sara ; Kreiswirth, Barry N. ; Mildvan, Donna. / Predictors and outcome of multidrug-resistant tuberculosis. In: Clinical Infectious Diseases. 1995 ; Vol. 21, No. 5. pp. 1245-1252.
@article{73739269c3b24a82870b8105b7b64986,
title = "Predictors and outcome of multidrug-resistant tuberculosis",
abstract = "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.",
author = "Nadim Salomon and Perlman, {David C.} and Patricia Friedmann and Sara Buchstein and Kreiswirth, {Barry N.} and Donna Mildvan",
year = "1995",
month = "1",
day = "1",
doi = "10.1093/clinids/21.5.1245",
language = "English (US)",
volume = "21",
pages = "1245--1252",
journal = "Clinical Infectious Diseases",
issn = "1058-4838",
publisher = "Oxford University Press",
number = "5",

}

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

PY - 1995/1/1

Y1 - 1995/1/1

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.

UR - http://www.scopus.com/inward/record.url?scp=85047698598&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85047698598&partnerID=8YFLogxK

U2 - 10.1093/clinids/21.5.1245

DO - 10.1093/clinids/21.5.1245

M3 - Article

VL - 21

SP - 1245

EP - 1252

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

SN - 1058-4838

IS - 5

ER -