PURPOSE: The aim of this study was to assess outcome of Multi Drug Resistant tuberculosis(MDR-TB)patients in Israel and to determine factors associated with treatment failure.
METHODS: This is a retrospective study that included patients hospitalized with a MDR TB in the national tuberculosis centers from January 2000 to December 2005. Their medical charts were examined for demographic, medical history, second line drugs susceptibility and outcome. The follow up was completed by telephone contact in the outpatient tuberculosis clinics over the subsequent 2 years.
RESULTS: A total of 137 patients were identified. The patients (median age of 41 years) were mainly males (78%), born in the Former Soviet Union - FSU(75.9%) . Pulmonary involvement predominate (90%) with a high rate of contagion (68% positive AFB). The rate of HIV coinfection (4.3%) was low. Assessment of treatment outcomes showed that 70 (51%) patients cured and completed therapy, 42(30.6%) died and 25(18.2%) failed. Factors associated with mortality and treatment failure were age (more than 40 years old, p=0.008), length of hospitalization (more than 12 months and repeat hospitalizations, p=0.033), alcohol abuse (p=0.0001), and more than 3 drugs resistance in the second line drugs (p= 0.04). A total of 14 (10%) patients turned to extensively drug resistance tuberculosis (XDR), 12 of them from the FSU, with a high mortality rate (78.5%) Second line drugs susceptibility testing showed a high rate of resistance for ethionamide 89 (65%), and for amikacin/ capreomycin 78 (57%).
CONCLUSION: In Israel, MDR-TB patients are not related to HIV infection and occur for the most in FSU native patients. The prognosis is bad especially in alcohol abuse and poor adherent patients.
CLINICAL IMPLICATIONS: Second line drugs therapy instituted earlier in the course of the disease will improve the prognosis and should be of value in these high risk patients.
DISCLOSURE: Daniele Bendayan, None.