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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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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| author | Emily E Evans Teona Avaliani Mariam Gujabidze Tinatin Bakuradze Maia Kipiani Shorena Sabanadze Alison G C Smith Zaza Avaliani Jeffrey M Collins Russell R Kempker |
| author_facet | Emily E Evans Teona Avaliani Mariam Gujabidze Tinatin Bakuradze Maia Kipiani Shorena Sabanadze Alison G C Smith Zaza Avaliani Jeffrey M Collins Russell R Kempker |
| author_sort | Emily E Evans |
| collection | DOAJ |
| description | <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. |
| format | Article |
| id | doaj-art-4e8fbe3bf9b441b5ba68f6f37c382c32 |
| institution | Kabale University |
| issn | 1932-6203 |
| language | English |
| publishDate | 2022-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj-art-4e8fbe3bf9b441b5ba68f6f37c382c322025-08-20T03:28:13ZengPublic Library of Science (PLoS)PLoS ONE1932-62032022-01-01176e027020110.1371/journal.pone.0270201Long term outcomes of patients with tuberculous meningitis: The impact of drug resistance.Emily E EvansTeona AvalianiMariam GujabidzeTinatin BakuradzeMaia KipianiShorena SabanadzeAlison G C SmithZaza AvalianiJeffrey M CollinsRussell R Kempker<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.https://doi.org/10.1371/journal.pone.0270201 |
| spellingShingle | Emily E Evans Teona Avaliani Mariam Gujabidze Tinatin Bakuradze Maia Kipiani Shorena Sabanadze Alison G C Smith Zaza Avaliani Jeffrey M Collins Russell R Kempker Long term outcomes of patients with tuberculous meningitis: The impact of drug resistance. PLoS ONE |
| title | Long term outcomes of patients with tuberculous meningitis: The impact of drug resistance. |
| title_full | Long term outcomes of patients with tuberculous meningitis: The impact of drug resistance. |
| title_fullStr | Long term outcomes of patients with tuberculous meningitis: The impact of drug resistance. |
| title_full_unstemmed | Long term outcomes of patients with tuberculous meningitis: The impact of drug resistance. |
| title_short | Long term outcomes of patients with tuberculous meningitis: The impact of drug resistance. |
| title_sort | long term outcomes of patients with tuberculous meningitis the impact of drug resistance |
| url | https://doi.org/10.1371/journal.pone.0270201 |
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