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Drug resistant TB: UK multicentre study (DRUMS): Treatment, management and outcomes in London and West Midlands 2008-2014.

Authors
  • Arnold, Amber1
  • Cooke, Graham S2
  • Kon, Onn Min3
  • Dedicoat, Martin4
  • Lipman, Marc5
  • Loyse, Angela6
  • Butcher, Philip D6
  • Ster, Irina Chis6
  • Harrison, Thomas Stephen6
  • 1 Institute for Infection and Immunity, St. George's University of London, London SW17 0RE, United Kingdom; Clinical Infection Unit, St George's Healthcare NHS Trust, London SW17 0QT, United Kingdom. Electronic address: [email protected] , (United Kingdom)
  • 2 Division of Medicine, Imperial College London, United Kingdom. , (United Kingdom)
  • 3 Tuberculosis Service, St Mary's Hospital, Imperial College Healthcare NHS Trust, United Kingdom. , (United Kingdom)
  • 4 Department of Infectious Diseases, Heart of England Foundation Trust, Birmingham, United Kingdom. , (United Kingdom)
  • 5 Royal Free London NHS Foundation Trust and UCL Respiratory, Division of Medicine, University College London, United Kingdom. , (United Kingdom)
  • 6 Institute for Infection and Immunity, St. George's University of London, London SW17 0RE, United Kingdom. , (United Kingdom)
Type
Published Article
Journal
The Journal of infection
Publication Date
Mar 01, 2017
Volume
74
Issue
3
Pages
260–271
Identifiers
DOI: 10.1016/j.jinf.2016.12.005
PMID: 27998752
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Detailed information regarding treatment practices and outcomes of MDR-TB treatment in the UK is required as a baseline for care improvements. 100 consecutive cases between 2008 and 2014 were reviewed retrospectively at 4 MDR-TB treatment centres in England to obtain information on drug treatment choices, hospital admission duration and outcomes for MDR-TB. Initial hospital admission was long, median 62.5 (IQR 20-106, n = 92) days, and 13% (12/92) of patients lost their home during this period. Prolonged admission was associated with pulmonary cases, cavities on chest radiograph, a public health policy of waiting for sputum culture conversion (CC) and loss of the patient's home. Sputum CC occurred at a median of 33.5 (IQR 16-55, n = 46) days. Treatment success was high (74%, 74/100) and mortality low (1%, 1/100). A significant proportion of the cohort had "neutral" results due to deportation and transfer overseas (12%, (12/100)). 14% (14/100) had negative outcomes for which poor adherence was the main reason (62%, 9/14). Successful outcome is common in recognised centres and limited by adherence rather than microbiological failure. Duration of hospital admission is influenced by lack of suitable housing and some variation in public health practice. Wider access to long-term assisted living facilities could improve completion rates. Copyright © 2016 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

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