Evaluation of drug-resistant tuberculosis treatment outcome in Portugal, 2000-2016

Olena Oliveira; Rita Gaio; Margarida Correia-Neves; Teresa Rito; Raquel Duarte

doi:10.1371/journal.pone.0250028

Evaluation of drug-resistant tuberculosis treatment outcome in Portugal, 2000-2016

PLoS One. 2021 Apr 20;16(4):e0250028. doi: 10.1371/journal.pone.0250028. eCollection 2021.

Authors

Olena Oliveira^{1

2

3}, Rita Gaio^{4

5}, Margarida Correia-Neves^{1

2}, Teresa Rito^{1

2

6}, Raquel Duarte^{3

7

8}

Affiliations

¹ Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.
² ICVS/3B, PT Government Associate Laboratory, University of Minho, Braga/Guimarães, Portugal.
³ EPIUnit, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal.
⁴ Department of Mathematics, Faculty of Sciences, University of Porto, Porto, Portugal.
⁵ Centre of Mathematics, University of Porto, Porto, Portugal.
⁶ Centre of Molecular and Environmental Biology (CBMA), University of Minho, Braga, Portugal.
⁷ Clinical Epidemiology, Predictive Medicine and Public Health Department, Faculty of Medicine, University of Porto, Porto, Portugal.
⁸ Pulmonology Unit, Centro Hospitalar de Vila Nova de Gaia/Espinho EPE, Vila Nova de Gaia, Portugal.

Abstract

Treatment of drug-resistant tuberculosis (TB), which is usually less successful than that of drug-susceptible TB, represents a challenge for TB control and elimination. We aimed to evaluate treatment outcomes and to identify the factors associated with death among patients with MDR and XDR-TB in Portugal. We assessed MDR-TB cases reported for the period 2000-2016, using the national TB Surveillance System. Treatment outcomes were defined according to WHO recommendations. We identified the factors associated with death using logistic regression. We evaluated treatment outcomes of 294 MDR- and 142 XDR-TB patients. The treatment success rate was 73.8% among MDR- and 62.7% among XDR-TB patients (p = 0.023). The case-fatality rate was 18.4% among MDR- and 23.9% among XDR-TB patients. HIV infection (OR 4.55; 95% CI 2.31-8.99; p < 0.001) and resistance to one or more second-line injectable drugs (OR 2.73; 95% CI 1.26-5.92; p = 0.011) were independently associated with death among MDR-TB patients. HIV infection, injectable drug use, past imprisonment, comorbidities, and alcohol abuse are conditions that were associated with death early on and during treatment. Early diagnosis of MDR-TB and further monitoring of these patients are necessary to improve treatment outcome.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Antitubercular Agents / therapeutic use*
Drug Resistance, Multiple, Bacterial / drug effects
Extensively Drug-Resistant Tuberculosis / drug therapy
Extensively Drug-Resistant Tuberculosis / epidemiology
Extensively Drug-Resistant Tuberculosis / mortality
HIV Infections / drug therapy
Humans
Microbial Sensitivity Tests
Mycobacterium tuberculosis / drug effects
Portugal / epidemiology
Treatment Outcome
Tuberculosis, Multidrug-Resistant / drug therapy*
Tuberculosis, Multidrug-Resistant / epidemiology
Tuberculosis, Multidrug-Resistant / mortality*

Substances

Antitubercular Agents

Grants and funding

This work was developed under the scope of the project NORTE-01-0145-FEDER-000013 and NORTE-01-0145-FEDER-000023, supported by the Northern Portugal Regional Operational Programme (NORTE 2020), under the Portugal 2020 Partnership Agreement, through the European Regional Development Fund (FEDER) and projects PTDC/SAU-PUB/29521/2017. This work was partially supported by “Contratos-Programa” UIDB/50026/2020 and UIDB/04050/2020 funded by national funds through the FCT - Foundation for Science and Technology, I.P. OO is supported by the project NORTE-08-5369-FSE-000041, financed by the Operational Program NORTE 2020 and co-financed by the European Social Fund through a doctoral grant (UMINHO/BD/47/2016). This work was also supported by national funds through the FCT, I.P., under the project UIDB / 04750/2020.