H. Snène

Healing predictors when treating MDR-TB

Introduction: The WHO estimates that 450000 people around the world have MDR-TB, in 2012, of which 170000 have died. This form of TB has a lower cure rate than simple TB, and this is due to the high cost, toxicity and prolonged duration of treatment. Aim: Determine predictors of a favorable outcome with healing in an MDR-TB. Methods: Retrospective study (2009- 2013) including patients with MDR-TB confirmed with drug sensitive test and treated according to WHO recommendations in the 2 referral centers for care of MDR-TB in Tunisia. Healing was declared when the patient has completed treatment with negative culture of KB five consecutive times in the last 12 months. Quantitative and qualitative variables were analyzed by SPSS17.0 software. Results: Fifty-four cases of MDR-TB (mean age was 38±13 years, sex ratio= 3.15) were collected. More than medical treatment, one patient was operated at 9 months of TB treatment. Recovery was reported in 32 cases, 14 are being treated, 5 died and 3 had treatment failure. Unemployment (n=12) was statistically significantly correlated with healing (p<0.05) because the patients were motivated by the financial support which they received during their follow-up. Moreover, healing was inversely correlated to the isolated resistance to isoniazid and rifampicin (p<0.01), the partial chest X-ray cleaning (p<0.01) and the absence of radiological improvement (p<0.05). Neither the absence of a history of TB nor good drug tolerance were correlated with favorable outcome. Conclusion: Treatment and monitoring of MDR-TB are interspersed with several challenges and outcome remains uncertain with a significant failure and death rates. Good adherence remains the only guarantee of a favorable outcome.