Pulmonary resection in the treatment of patients with pulmonary multidrug-resistant tuberculosis in Taiwan
OBJECTIVE: To evaluate the role of pulmonary resection in the treatment of pulmonary tuberculosis resistant to isoniazid and rifampin (MDR-TB).
DESIGN: In a retrospective cohort study, 27 MDR-TB patients who underwent pulmonary resection between December 1990 and March 1999 were reviewed. Individually-tailored treatment regimens were selected at a once-weekly staff conference following review of the patientÕs case history and drug susceptibility results. Surgery was performed for selected patients, essentially those: 1) whose medical treatment had failed, or for whom treatment failure seemed highly likely, or for whom post-treatment relapse seemed likely, 2) with predominantly localised disease, 3) with adequate cardiopulmonary reserve, and 4) whose treatment regimen had been composed of at least two effective drugs to diminish the mycobacterial burden.
RESULTS: There was no surgical mortality apart from one peri-operative death (4%). Three patients (11%) developed complications, and 24 (92%) patients demonstrated sputum conversion and/or remained negative after surgery. Twenty-three patients have already completed treatment, and during a mean of 42 ± 18 follow-up months (range 15–80 months), one patient relapsed. This patient was disease-free after another course of treatment.
CONCLUSION: For selected patients, pulmonary resection may improve the outcome of pulmonary MDR-TB.
Document Type: Regular Paper
Affiliations: 1: Chronic Disease Control Bureau, Department of Health, Shen-Keng Shiang, Taipei County, Tiawan, Republic of China 2: Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan, Republic of China
Publication date: 2001-03-01
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