       Document 0995
 DOCN  M9650995
 TI    Improved outcomes for patients with multidrug-resistant tuberculosis.
 DT    9505
 AU    Turett GS; Telzak EE; Torian LV; Blum S; Alland D; Weisfuse I; Fazal BA;
       Department of Medicine, Bronx-Lebanon Hospital Center, New York; 10457,
       USA.
 SO    Clin Infect Dis. 1995 Nov;21(5):1238-44. Unique Identifier : AIDSLINE
       MED/96126010
 AB    We conducted a retrospective study of patients with culture-confirmed
       multidrug-resistant tuberculosis (MDR-TB) at Bronx-Lebanon Hospital
       Center (South Bronx, NY) to determine what factors affected clinical and
       microbiological responses and survival. For the 38 patients with MDR-TB,
       reporting of first-line drug susceptibilities was relatively rapid
       (median time, 30 days). Thirty-four patients (89%) were infected with
       human immunodeficiency virus (HIV), and initial and overall response
       rates were 59% and 50%, respectively; the median survival was 315 days;
       and 50% of these patients died of tuberculosis. Bivariate analysis
       revealed that the following factors had a positive impact on response
       and survival: receiving > or = 2 consecutive weeks of appropriate
       therapy with at least two drugs to which the isolate was susceptible in
       vitro; starting appropriate therapy within 4 weeks of the diagnosis; and
       having tuberculosis that was limited to the lungs. Multivariate analysis
       revealed that the only variable associated with response was receipt of
       appropriate therapy for > or = 2 consecutive weeks. In contrast to
       findings in the published literature, our results indicate the outcome
       of MDR-TB can be improved, particularly for severely immunosuppressed
       HIV-infected patients. Rapid reporting of susceptibilities and prompt
       initiation and continuation of appropriate antituberculous therapy
       improved response and survival.
 DE    Adult  Antitubercular Agents/*THERAPEUTIC USE  AIDS-Related
       Opportunistic Infections/COMPLICATIONS/DRUG THERAPY/  MICROBIOLOGY  Drug
       Resistance, Multiple/GENETICS  Female  Human  Male  Middle Age
       Mycobacterium tuberculosis/DRUG EFFECTS/GENETICS/ISOLATION &  PURIF
       Polymorphism, Restriction Fragment Length  Retrospective Studies
       Treatment Outcome  Tuberculosis, Multidrug-Resistant/COMPLICATIONS/*DRUG
       THERAPY/  MICROBIOLOGY  Tuberculosis, Pulmonary/COMPLICATIONS/*DRUG
       THERAPY/MICROBIOLOGY  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

