gms | German Medical Science

10. Kongress für Infektionskrankheiten und Tropenmedizin (KIT 2010)

Deutsche Gesellschaft für Infektiologie,
Deutsche AIDS-Gesellschaft,
Deutsche Gesellschaft für Tropenmedizin und Internationale Gesundheit,
Paul-Ehrlich-Gesellschaft für Chemotherapie

23.06. - 26.06.2010, Köln

Highly individualized treatment for XDR-/MDR-tuberculosis: case series from single centre

Individualisierte Therapie der XDR-/MDR-Tuberkulose: eine monozentrische Fallstudie

Meeting Abstract

  • T. Grünewald - Klinikum St. Georg gGmbH, Klinik für Infektiologie, Tropenmedizin und Nephrologie, Leipzig, Germany
  • S. Höhne - Heinrich-Braun-Klinikum, Klinik für Innere Medizin II, Zwickau, Germany
  • I. Raila - Klinikum St. Georg gGmbH, Klinik für Infektiologie, Tropenmedizin und Nephrologie, Leipzig, Germany
  • S. Weigold - Klinikum St. Georg gGmbH, Klinik für Infektiologie, Tropenmedizin und Nephrologie, Leipzig, Germany
  • T. Marcello - Klinikum St. Georg gGmbH, Klinik für Infektiologie, Tropenmedizin und Nephrologie, Leipzig, Germany
  • K. Schreiter - Klinikum St. Georg gGmbH, Klinik für Infektiologie, Tropenmedizin und Nephrologie, Leipzig, Germany
  • S. Glas - Klinikum St. Georg gGmbH, Klinik für Infektiologie, Tropenmedizin und Nephrologie, Leipzig, Germany
  • N. Schultheis - Klinikum St. Georg gGmbH, Klinik für Infektiologie, Tropenmedizin und Nephrologie, Leipzig, Germany
  • R. Schröder - Klinikum St. Georg gGmbH, Zentrum für Klinische Chemie, Mikrobiologie und Transfusionsmedizin, Leipzig, Germany
  • M. Lindner - Klinikum St. Georg gGmbH, Zentrum für Klinische Chemie, Mikrobiologie und Transfusionsmedizin, Leipzig, Germany
  • B.R. Ruf - Klinikum St. Georg gGmbH, Klinik für Infektiologie, Tropenmedizin und Nephrologie, Leipzig, Germany

10. Kongress für Infektionskrankheiten und Tropenmedizin (KIT 2010). Köln, 23.-26.06.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocP65

DOI: 10.3205/10kit121, URN: urn:nbn:de:0183-10kit1215

Published: June 2, 2010

© 2010 Grünewald et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Objective: Treatment options for patients with extensively resistant (XDR) or multi-drug resistant (MDR) tuberculosis (TB) are highly limited. Individualized treatment using WHO group II, IV or V tuberculostatic substances may improve outcomes.

Goal: To determine the clinical and microbiological outcomes of patients with confirmed MDR- or XDR-TB.

Patients and Methods: Retrospective analysis of all MDR- und XDR-TB cases in a single tertiary referral centre. Outcomes were correlated with underlying conditions, treatment schedules, duration of treatment and microbiological treatment response.

Results: From 2006 to 2009 eleven patients with either XDR (n=5) or MDR-TB (n=6) were recorded. Pulmonary manifestations were present in 10/11, one patient had only extrapulmonary tuberculosis (pleural, mammary and lymph node involvement). Disseminated disease involving lung, liver, spleen, lymph nodes or central nervous system was found in three patients. Eight out of eleven patients were from Eastern Europe (Russia, Ukraine, Georgia) two from Asia (Iran, Afghanistan), and one from Africa (Cameroon). Underlying condition were found in four (HIV infection, n=1; HCV infection, n=2, HIV/HCV co-infection, n=1). Nearly all (10/11) had at least one incomplete tuberculostatic pre-treatment (duration 3 months to five years, in all cases non-compliance was documented). Isolated strains were resistant to a median of five antituberculous drugs (range 3–8). Treatment regimens provided by DOT in every patient included mainly WHO group IV and V drugs with at least three drugs selected by susceptibility testing (median 3, range 3–5). Two patients underwent surgery (lung surgery, n=1; pleurectomy, n=1). Microbiological, radiological and clinical cure was documented in 8/11 (72.7%) and improvement with ongoing treatment in 2/11 (18.2%). One patient died after upper lobe resection because of pulmonary thromboembolism.

Conclusions: Prognosis in patients having at least three effective substances left is favourable. Complete cure can be achieved by implementing DOT strategies for the long-term therapy. Drug compliance history is crucial for estimating prognosis and guides the management of patients especially with XDR-TB.

Conflict of Interest: None.