Outcome of Multidrug-Resistant Tuberculosis in Human Immunodeficiency Virus-Infected Patients

• Published in: Clinical infectious diseases Vol. 29; no. 3; pp. 553 - 560
• Main Authors: Franzetti, Fabio, Gori, Andrea, Iemoli, Enrico, Meraviglia, Paola, Mainini, Franco, Quirino, Tiziana, degli Esposti, Anna, degl'Innocenti, Maura, Grassini, Anna, Nardi, Giampiero, Cargnel, Antonietta
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Chicago, IL The University of Chicago Press 01-09-1999; University of Chicago Press
• Subjects: Adult; AIDS; AIDS-Related Opportunistic Infections - diagnosis; AIDS-Related Opportunistic Infections - drug therapy; AIDS-Related Opportunistic Infections - mortality; AIDS/HIV; Analysis of Variance; Antitubercular Agents - therapeutic use; Antituberculars; Biological and medical sciences; Clinical Articles; Cross Infection - diagnosis; Cross Infection - drug therapy; Cross Infection - mortality; Disease outbreaks; Drug Resistance, Multiple; Epidemiology; Female; Hospitals - statistics & numerical data; Human viral diseases; Humans; Infectious diseases; Italy - epidemiology; Lungs; Male; Medical sciences; Microbial Sensitivity Tests; Middle Aged; Multidrug resistant tuberculosis; Mycobacterium tuberculosis; Polymerase Chain Reaction; Proportional Hazards Models; Pulmonary tuberculosis; Survival Analysis; Survival Rate; Symptoms; Treatment Outcome; Tuberculosis; Tuberculosis, Multidrug-Resistant - diagnosis; Tuberculosis, Multidrug-Resistant - drug therapy; Tuberculosis, Multidrug-Resistant - mortality; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Italy; Human; Immunopathology; Opportunistic infection; Prognosis; Drug susceptibility test; AIDS; Mycobacterial infection; Immune deficiency; Infection; Chemotherapy; Treatment; Tuberculosis; Mycobacterium tuberculosis; Mycobacteriales; Viral disease; Multiple resistance; Bacteriosis; Mycobacteriaceae; Bacteria; Complication; Actinomycetes; Antituberculous agent; Antibacterial agent
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1086/598633

Among 324 cases of culture-proven tuberculosis from 1988 to 1996 in a hospital in Milan, Italy, 90 (27,8%) were due to Mycobacterium tuberculosis strains resistant to isoniazid and rifampin. Sixty-one of 69 isolates tested had identical restriction fragment length polymorphism patterns. The prevalent strain tested susceptible only to ethionamide and was also resistant to ethambutol, streptomycin, cycloserine, amikacin, kanamycin, terizodone, ofloxacin, rifabutin, rifapentin, and KRM 1648. The median survival time was 94 days, Multivariate analysis showed a trend toward better outcome in the period 1994–1996 (hazard ratio, 4.16; P < .001), and extrapulmonary localization of tuberculosis was the only other independent predictor of a negative outcome (hazard ratio, 2.1; P = .019). The delay from symptoms to beginning of therapy did not seem to be a determining factor in survival time. Standard antituberculosis therapy with four drugs (isoniazid, rifampin, ethambutol, and pyrazinamide) had a higher efficacy than did other regimens with fewer drugs but without a statistically significant difference.