BACKGROUND: Recent outbreaks of pulmonary disease due to drug-resistant strains of Mycobacterium Tuber-culosis have resulted in significant morbidity and mortality in patients worldwide. We reviewed our experience to evaluate the effects of pulmonary resection on the managenent of multidrug-resistant tuberculosis. METHOD: A retrospective review was performed of 41 patients undergoing pulmonary resection for multidrug-resistant tuberculosis between January 1993 and December 1997. We divided these into 3 groups according to the radiologic findigs : (1) patients who have reasonably localized lesion ( Localized Lesion Group ; LLG) (2) patients who have cavitary lesion after pulmonary resection on chest roentgenogram (Remained Cavity Group : RCG). (3) patients who have Remained infiltrative lesions postoperatively (Remained infiltrative group : RIG). We evaluated the negative conversion rate after resection and overall response rate of the groups. Then they were compared with the results of the chemotherapy on the multidrug-resistant tuberculosis which has been outcome by Goble et al. Goble et al reported that negative conversion rate was 65% and overall response rate, 56% over a mean period of 5.1 months. RESULTS: Seventy five point six percent were men and 24.4% woment with a median age of 31 years (range, 16 to 60 years). Although the patients were treated preoperatively with multidrug regimens in an effort to reduce the mycobacterial burden, 22 of 41 were still sputum culture positive at the time of surgery. 20 of 22 patients (90.9%, p<0.01) responded which is defined as negative sputum cultures within 2 months postoperative. Of 26 patients with the sufficient follow up data, 19 have Remained sputum culture negative for a mean duration of 25.7 months (73.1%, p<0.05). The bulk of the disease was manifest in one lung, but lesser amounts of contralateral disease were demonstrated in 15, consisted of 8 in RIG and 7 in RCG, of 41. 12 of 12 patients (100%, p<0.01) who were sputum positive at the time of surgery in LLG converted successfully. 14 of 15 patients (93.3%, p<0.05) with the follow up have completed treatment and not relapsed for a mean period of 25.7 months. The mean length of postoperative drug therapy off LLG was 12.2 months. In RIG, postoperative negative conversion rate was 83.3% which was not significant statistically. There was a statistical significance in overall response rate (100%, p<0.05) of RIG for a mean period of 24.4 months with a mean length of postoperative chemotherapy, 11.8 months. In RCG a statistically lower overall response rate (14.3%, p<0.01) has been revealed for a mean duration of follow up, 24.2 months. A negative conversion rate of RCG was 75% which was not significant statistically. CONCLUSION: Surgery plays an important role in the management of patients with multidrug-resistant Mycobacterium tuberculosis infection. Aggressive pulmonary resection should be performed for resistant Mycobacterium tuberculosis infection to avoid treatment failture or relapse. Especially all cavitary lesions on preoperative chest roentgenogram should be resected completely. If all them could not be resected perfectly, you should not open the thorax.
Disease Outbreaks ; Drug Therapy ; Follow-Up Studies ; Humans ; Lung ; Lung Diseases ; Male ; Mortality ; Mycobacterium ; Mycobacterium tuberculosis ; Recurrence ; Retrospective Studies ; Sputum ; Thorax ; Tuberculosis, Multidrug-Resistant*

BACKGROUND/AIMS: To compare the effect of levofloxacin and moxifloxacin on treatment outcomes among patients with multidrug-resistant tuberculosis (MDR-TB). METHODS: A retrospective analysis of 171 patients with MDR-TB receiving either levofloxacin or moxifloxacin was performed. Treatment responses were categorized into treatment success (cured and treatment completed) or adverse treatment outcome (death, failure, and relapsed). RESULTS: The median age of the patients was 42.0 years. Approximately 56% of the patients were male. Seventeen patients had extensively drug-resistant tuberculosis, and 20 had a surgical resection. A total of 123 patients (71.9%) received levofloxacin for a median 594 days, and 48 patients (28.1%) received moxifloxacin for a median 673 days. Other baseline demographic, clinical, and radiographic characteristics were similar between the two groups. The moxifloxacin group had a significantly higher number of resistant drugs (p < 0.001) and a higher incidence of resistance to ofloxacin (p = 0.005) in the drug sensitivity test. The treatment success rate was 78.9% in the levofloxacin group and 83.3% in the moxifloxacin group (p = 0.42). Adverse reactions occurred at similar rates in the groups (p = 0.44). Patients in the moxifloxacin group were not more likely to have treatment success than those in the levofloxacin group (adjusted odds ratio, 0.76; 95% confidence interval, 0.24 to 2.43; p = 0.65). CONCLUSIONS: Both levofloxacin and moxifloxacin showed equivalent efficacy for treating MDR-TB.
Adult ; Antitubercular Agents/adverse effects/*therapeutic use ; Aza Compounds/adverse effects/*therapeutic use ; Case-Control Studies ; Chi-Square Distribution ; *Drug Resistance, Multiple, Bacterial ; Drug Therapy, Combination ; Extensively Drug-Resistant Tuberculosis/*drug therapy/microbiology/mortality ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Mycobacterium tuberculosis/*drug effects/pathogenicity ; Odds Ratio ; Ofloxacin/adverse effects/*therapeutic use ; Quinolines/adverse effects/*therapeutic use ; Recurrence ; Remission Induction ; Republic of Korea ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Time Factors ; Treatment Outcome ; Tuberculosis, Multidrug-Resistant/*drug therapy/microbiology/mortality

This study was conducted to evaluate treatment outcome, mortality, and predictors of both in patients with multidrug-resistant tuberculosis (MDR-TB) at 3 TB referral hospitals in the public sector of Korea. We included MDR-TB patients treated at 3 TB referral hospitals in 2004 and reviewed retrospectively their medical records and mortality data. Of 202 MDR-TB patients, 75 (37.1%) had treatment success and 127 (62.9%) poor outcomes. Default rate was high (37.1%, 75/202), comprising 59.1% of poor outcomes. Male sex (adjusted odds ratio [aOR], 2.91; 95% confidence interval [CI], 1.13-7.49), positive smear at treatment initiation (aOR, 5.50; 95% CI, 1.22-24.90), and extensively drug-resistant TB (aOR, 10.72; 95% CI, 1.23-93.64) were independent predictors of poor outcome. The all-cause mortality rate was 31.2% (63/202) during the 3-4 yr after treatment initiation. In conclusion, the treatment outcomes of patients with MDR-TB at the 3 TB hospitals are poor, which may reflect the current status of MDR-TB in the public sector of Korea. A more comprehensive program against MDR-TB needs to be integrated into the National Tuberculosis Program of Korea.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Antitubercular Agents/*therapeutic use ; Demography ; Drug Resistance, Multiple, Bacterial ; Drug Therapy, Combination ; Female ; Hospitals, Chronic Disease ; Humans ; Male ; Middle Aged ; Odds Ratio ; Predictive Value of Tests ; Retrospective Studies ; Sex Factors ; Treatment Outcome ; Tuberculosis, Multidrug-Resistant/drug therapy/*mortality

This study was conducted to evaluate treatment outcome, mortality, and predictors of both in patients with multidrug-resistant tuberculosis (MDR-TB) at 3 TB referral hospitals in the public sector of Korea. We included MDR-TB patients treated at 3 TB referral hospitals in 2004 and reviewed retrospectively their medical records and mortality data. Of 202 MDR-TB patients, 75 (37.1%) had treatment success and 127 (62.9%) poor outcomes. Default rate was high (37.1%, 75/202), comprising 59.1% of poor outcomes. Male sex (adjusted odds ratio [aOR], 2.91; 95% confidence interval [CI], 1.13-7.49), positive smear at treatment initiation (aOR, 5.50; 95% CI, 1.22-24.90), and extensively drug-resistant TB (aOR, 10.72; 95% CI, 1.23-93.64) were independent predictors of poor outcome. The all-cause mortality rate was 31.2% (63/202) during the 3-4 yr after treatment initiation. In conclusion, the treatment outcomes of patients with MDR-TB at the 3 TB hospitals are poor, which may reflect the current status of MDR-TB in the public sector of Korea. A more comprehensive program against MDR-TB needs to be integrated into the National Tuberculosis Program of Korea.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Antitubercular Agents/*therapeutic use ; Demography ; Drug Resistance, Multiple, Bacterial ; Drug Therapy, Combination ; Female ; Hospitals, Chronic Disease ; Humans ; Male ; Middle Aged ; Odds Ratio ; Predictive Value of Tests ; Retrospective Studies ; Sex Factors ; Treatment Outcome ; Tuberculosis, Multidrug-Resistant/drug therapy/*mortality