993. Short term and long term outcomes of the first cohort attending a DOTS- plus program for treatment of multidrug resistant tuberculosis (MDR-TB) in Orel Oblast, Russian Federation
Session: Poster Abstract Session: Clinical Studies of Tuberculosis
Saturday, October 22, 2011
Room: Poster Hall B1
Handouts
  • Nguyen_Orel Outcomes_posterIDSA.pdf (120.6 kB)
  • Background:  In response to the rising global rate of MDR-TB, the World Health Organization promoted an expanded treatment strategy called DOTS-plus.

    Methods:  Medical charts and microbiology reports of the first cohort of 200 patients treated under DOTS-plus in Orel Oblast, Russian Federation, were abstracted.  We analyze the short-and long- term outcome of MDR-TB treatment in the first cohort enrolled in the Orel Oblast DOTS-plus program from Nov 2002 to Jul 2005.  

    Results: 198/200 patients with culture-confirmed pulmonary MDR-TB were enrolled: 54 were newly diagnosed MDR-TB patients (new) and 144 were retreatment patients (RT) including 42 (30%) previously treated with first line drugs only and 101 (70%) treated with second line drugs. Patients' cultures were resistant to a median of 4 drugs.  94% of the new and 97% of the RT patients received either kanamycin or capreomycin and a fluoroquinolone along with 2 to 3 other active agents in their initial treatment regimens. The mean duration of treatment was 403 (std. dev. =229 days); 108 (55%) were cured, 10 (5%) completed treatment, 26 (13%) defaulted, treatment failed in 30 (15%), 18 (9%) died and 6 (3%) transferred out. Ten patients (5%) developed extensively drug resistant (XDR) TB during treatment. Of 115 patients with at least 6 month of follow-up sputum culture surveillance data after the end of treatment, 13 (11%) developed XDR after treatment ended, 2 of whom had been reported as cured. Among 70 patients who were documented as cured or completed treatment and had culture surveillance for at least one year after the end of treatment, 7 (10%) had positive sputum cultures over an average of 434 days from the end of treatment

    Conclusion: The proportion of good outcomes (cure or treatment complete) was 60% overall, and relapse or re-infection occurred in 10 % of those with longer term surveillance. A substantial proportion of patients with follow-up data developed XDR-TB. Programmatic efforts should target preventing treatment defaults. Further studies with longer term follow up as well as molecular genotyping are needed to assess relapse after MDR TB treatment. 


    Subject Category: C. Clinical studies of bacterial infections and antibacterials including sexually transmitted diseases and mycobacterial infections (surveys, epidemiology, and clinical trials)

    Minh Ly Nguyen, MD, MPH, Emory University School of Medicine, Atlanta, GA; Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA; GRADY HEALTH SYSTEM, decatur, GA, T. Koroshova, MD, Orel TB Department, Orel Obalst, Russia, Joseph Cavanaugh, MD, Department of TB Elimination, Center for Diseases Control and Prevention, Decatur, GA, E. Sergeevna, MD, Orel TB Department, Orel Oblast, Russia, E. Vitalavnia, MD, Orel TB Department, Orel obalst, Russia, Erika Vitek, MD, CDC , Decatur, GA, Peter Cegielski, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA and B.Y. Kazennyy, MD, Orel TB Department, Orel Oblast, Russia

    Disclosures:

    M. L. Nguyen, None

    T. Koroshova, None

    J. Cavanaugh, None

    E. Sergeevna, None

    E. Vitalavnia, None

    E. Vitek, None

    P. Cegielski, None

    B. Y. Kazennyy, None

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.