Authors: Ferrara, G.¹; Richeldi, L.¹; Bugiani, M.²; Cirillo, D.³; Besozzi, G.⁴; Nutini, S.⁵; Casali, L.⁶; Fiorentini, F.⁷; Codecasa, L.R.⁸; Migliori, G.B.⁹

Source: The International Journal of Tuberculosis and Lung Disease, Volume 9, Number 5, May 2005 , pp. 507-513(7)

Publisher: International Union Against Tuberculosis and Lung Disease

Abstract:

SETTING: SMIRA (Italian Study on Anti-Tuberculosis Drug Resistance) network, 46 major clinical units and 22 laboratories nationwide in Italy.

OBJECTIVES: To determine the main features, adherence to WHO guidelines and the outcomes of multidrug-resistant tuberculosis (MDR-TB) patients enrolled from January 1995 to December 1999.

DESIGN: Observational study, preceded by proficiency testing, according to WHO recommendations. Results were stratified by appropriate and inappropriate regimens (< three active drugs). Analysis of the outcomes was performed according to adequacy of treatment. Analysis of risk factors and factors predicting treatment outcomes was performed using univariate and multivariate analysis (level of significance P < 0.05).

RESULTS: One hundred and twenty-seven MDR patients were diagnosed. The overall success rate was low (39%). Seventy per cent of cases were treated with at least three active drugs. Factors predicting treatment success were new MDR-TB cases (OR 3.45; 95%CI 1.22–9.78; P < 0.05) and treatment for 12 months (OR 5.03; 95%CI 1.65–15. 31; P < 0.05). Immigration and HIV infection were the main risk factors among new MDR-TB cases.

CONCLUSION: The best available treatment should be provided to all newly diagnosed MDR-TB patients, avoiding the use of poorly modified regimens. MDR-TB patients should be referred to highly specialised centres.

Keywords: tuberculosis; MDR; management; Italy

Document Type: Regular paper

Affiliations: 1: Respiratory Diseases Section, University of Modena and Reggio Emilia, Modena, Italy 2: Pneumology Department, CPA-ASL4 of Piemonte, Piemonte Region, Italy 3: Emerging Infectious Diseases Unit, San Raffaele-Turro Hospital, Milano, Italy 4: Tuberculosis Department, E. Morelli Hospital, Sondalo, Italy 5: Pneumology Department, Careggi Hospital, Firenze, Italy 6: Department of Pulmonary Diseases, University of Terni, Terni, Italy 7: Pneumology Department, Vecchiazzano Hospital, Forlì, Italy 8: Villa Marelli Institute, Niguarda Hospital, Reference Centre for Tuberculosis Lombardia Region, Milano, Italy 9: Clinical Epidemiology of Respiratory Diseases Service/Pneumology Department, WHO Collaborating Centre for Tuberculosis and Lung Diseases, Fondazione S. Maugeri Care and Research Institute, Tradate, Italy

Publication date: 2005-05-01

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• The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

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