Long term outcomes of patients with tuberculous meningitis: The impact of drug resistance.
<h4>Background</h4>Little is known about the impact of drug-resistance on clinical outcomes among patients with tuberculosis meningitis (TBM).<h4>Methods</h4>A retrospective cohort study among patients treated for TBM in Tbilisi, Georgia. We performed medical chart abstractio...
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| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2022-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0270201 |
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| Summary: | <h4>Background</h4>Little is known about the impact of drug-resistance on clinical outcomes among patients with tuberculosis meningitis (TBM).<h4>Methods</h4>A retrospective cohort study among patients treated for TBM in Tbilisi, Georgia. We performed medical chart abstraction to collect patient data. Long-term vital status was assessed using the Georgia National Death Registry. We utilized a Cox proportional-hazards model to evaluate the association of drug-resistance and mortality.<h4>Results</h4>Among 343 TBM suspects, 237 had a presentation consistent with TBM. Drug resistance was suspected (n = 5) or confirmed (n = 31) in 36 patients including 30 with multidrug- or rifampin-resistance and 6 with isoniazid-resistance. Thirty-four patients had HIV. The median follow-up time was 1331 days (IQR, 852-1767). Overall, 73 of 237 (30%) people died with 50 deaths occurring during and 23 after treatment. The proportion of death was higher among patients with drug-resistant vs. drug-susceptible disease (67% vs. 24%, p<0.001) and with HIV versus no HIV (59% vs 27%, p<0.001). Mortality was significantly higher in patients with drug-resistant TBM after 90 days of treatment (aHR = 7.2, CI95% [3.6-14.3], p < 0.001).<h4>Conclusions</h4>Mortality was high among patients with drug-resistant TBM with many deaths occurring post treatment. More effective treatment options are urgently needed for drug-resistant TBM. |
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| ISSN: | 1932-6203 |