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Treatment outcomes of multidrug-resistant tuberculosis patients in Gauteng, South Africa

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Abstract

Purpose

Multidrug-resistant tuberculosis (MDR-TB) is associated with lengthy treatment, expensive and potentially toxic regimens, and high rates of treatment failure and death. This study describes the outcomes of 351 MDR-TB patients who started treatment between 2004 and 2007 at the provincial MDR-TB referral hospital in Johannesburg, South Africa, and investigates risk factors associated with death.

Methods

The study involved the assessment of factors associated with treatment outcomes using a retrospective review of patient records, drug-susceptibility data and spoligotyping of isolates.

Results

Treatment success (completion/cure) was recorded in 158 (48.8 %) patients, while 65 (20 %) died, 93 (28.7 %) defaulted, 8 (2.5 %) failed treatment, 11(3.1 %) were transferred out to other health facilities and 16 (4.6 %) had no recorded final outcome. The proportion of successful treatment increased significantly over time. Univariable and multivariable analysis (P = 0.05) identified the year of MDR-TB diagnosis and spoligotype-defined families as factors associated with treatment outcome. No associations were found between treatment outcome and human immunodeficiency virus (HIV) status, previous TB and additional MDR resistance to streptomycin or ethambutol. Molecular typing of the strains revealed a diverse group of spoligotypes, with Beijing, LAM4 and H3 making up the largest groups.

Conclusions

This is the first published study to investigate treatment outcomes at this facility and to find a link between genotype and treatment outcome, suggesting that genotype determination could potentially serve as a prognostic factor.

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Acknowledgements

The authors would like to thank the staff of the Tuberculosis Referral Laboratory, National Health Laboratory Service, Johannesburg, the Pasteur Institute in Guadeloupe, University of Stellenbosch (Tygerberg) and University of the Witwatersrand (CMID) for their assistance. We thank Dr. A. Dziewiecki, Sizwe Hospital, for the important discussions.

This work was supported by the South African Tuberculosis AIDS Training (SATBAT) programme (National Institutes of Health/Fogarty International Center 1U2RTW007370/3), the Third World Organization for Women in Science (TWOWS), University of the Witwatersrand Health Sciences, European Regional Development Fund, European Commission (ERDF/FEDER, A34-05) and the Regional Council of Guadeloupe (Biodiversity project, CR08/031380), Medical Research Council of South Africa and the DST/NRF Centre of Excellence for Biomedical TB Research. Dr. Zozio was awarded a Ph.D. fellowship by the European Social Funds through the Regional Council of Guadeloupe. James Lewis was funded by the Consortium to Respond Effectively to the AIDS/TB Epidemic (CREATE), United States, who received funding from the Bill and Melinda Gates Foundation.

Conflict of interest

There are no conflicts of interest.

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Authors and Affiliations

  1. Department of Clinical Microbiology and Infectious Diseases, School of Pathology, University of the Witwatersrand and National Health Laboratory Service, Johannesburg, South Africa

    E. Marais, C. K. Mlambo, M. P. Grobusch & A. Duse

  2. MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK

    J. J. Lewis

  3. WHO Supranational TB Reference Laboratory, TB Mycobacteria Unit, Institut Pasteur de la Guadeloupe, Abymes, France

    N. Rastogi & T. Zozio

  4. Department of Infectious Diseases, Center of Tropical Medicine and Travel Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

    M. P. Grobusch

  5. Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Health Sciences, DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, US/MRC Centre for Molecular and Cellular Biology, Stellenbosch University, Tygerberg, South Africa

    T. Victor & R. W. Warren

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  1. E. Marais
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Correspondence to E. Marais.

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Marais, E., Mlambo, C.K., Lewis, J.J. et al. Treatment outcomes of multidrug-resistant tuberculosis patients in Gauteng, South Africa. Infection 42, 405–413 (2014). https://doi.org/10.1007/s15010-013-0572-2

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  • DOI: https://doi.org/10.1007/s15010-013-0572-2

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