Volume 21, Number 6—June 2015
CME ACTIVITY - Research
Acquired Drug Resistance in Mycobacterium tuberculosis and Poor Outcomes among Patients with Multidrug-Resistant Tuberculosis
Russell R. Kempker
, Maia Kipiani, Veriko Mirtskhulava, Nestani Tukvadze, Matthew J. Magee, and Henry M. Blumberg
, Maia Kipiani, Veriko Mirtskhulava, Nestani Tukvadze, Matthew J. Magee, and Henry M. Blumberg
Table 4
Risk factors for poor treatment outcomes among patients treated for multidrug-resistant tuberculosis, Georgia, March 2009–October 2012*
| Risk factor | Univariate analysis, OR (95% CI) | p value | Multivariate analysis, aOR (95% CI) | p value |
|---|---|---|---|---|
| Acquired resistance to any second-line drug | 14.88 (3.28–67.42) | <0.01 | 8.05 (1.56–41.66) | 0.01 |
| Baseline characteristics | ||||
| Increasing age per year | 1.02 (0.99–1.05) | 0.14 | 1.02 (0.99–1.05) | 0.26 |
| Male sex | 2.00 (0.91–4.40) | 0.08 | – | |
| BMI ≤18.5 kg/m2 | 0.82 (0.38–1.79) | 0.62 | – | – |
| History of TB | 1.26 (0.65–2.48) | 0.50 | – | – |
| Prior receipt of second-line TB drugs | 1.32 (0.37–4.79) | 0.67 | – | - |
| Diabetes mellitus | 0.75 (0.26–2.20) | 0.60 | – | – |
| Hepatitis C | 1.78 (0.62–509) | 0.28 | – | – |
| HIV | 1.31 (0.26–6.73) | 0.75 | – | – |
| Baseline cavitary disease | 1.96 (0.87–4.44) | 0.11 | 0.72 (0.25–2.05) | 0.54 |
| Resistant to ≥6 drugs by baseline DST | 2.01 (1.02–3.98) | 0.04 | 1.45 (0.68–3.11) | 0.34 |
| No. drugs to which baseline isolate was resistant (IQR) | 1.20 (0.90–1.59) | 0.21 | – | – |
| Drug resistance category | ||||
| Baseline ofloxacin resistant | 2.76 (0.66–11.53) | 0.16 | – | – |
| Baseline capreomycin or kanamycin resistant | 1.58 (0.78–3.20) | 0.21 | – | – |
| Follow-up characteristics | ||||
| Treatment interruption | 1.75 (0.88–3.46) | 0.11 | – | – |
| >30 d to start SLDs | 0.92 (0.47–1.79) | 0.80 | – | – |
| Initial capreomycin treatment | 0.68 (0.35–1.33) | 0.26 | – | – |
| Baseline sputum smear AFB value >3+ | 1.47 (0.73–3.00) | 0.28 | – | – |
| Sputum smear positive, mo† | ||||
| 4‡ | 2.78 (1.38–5.60) | <0.01 | – | – |
| 6 | 5.25 (2.33–11.81) | <0.01 | 3.43 (1.36–8.63) | 0.01 |
| Sputum culture positivity,mo | ||||
| 4‡ | 3.09 (1.51–6.31) | <0.01 | – | – |
| 6‡ | 5.85 (2.71–12.59) | <0.01 | – | – |
*OR, odds ratio; aOR, adjusted OR; –, not included in multivariate analysis; BMI, body mass index; TB, tuberculosis; IQR, interquartile range; DST, drug susceptibility testing; SLDs, second-line drugs; AFB, acid-fast bacilli.
†Time from initiation of second-line drug treatment for MDR TB.
‡Significant by alternative multivariate analysis models when replacing the variable sputum smear positive at 6 mo.
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