Amber Arnold1, Graham S Cooke2, Onn Min Kon3, Martin Dedicoat4, Marc Lipman5, Angela Loyse6, Philip D Butcher6, Irina Chis Ster6, Thomas Stephen Harrison6. 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: amber.arnold@doctors.org.uk. 2. Division of Medicine, Imperial College London, United Kingdom. 3. Tuberculosis Service, St Mary's Hospital, Imperial College Healthcare NHS Trust, United Kingdom. 4. Department of Infectious Diseases, Heart of England Foundation Trust, Birmingham, United Kingdom. 5. Royal Free London NHS Foundation Trust and UCL Respiratory, Division of Medicine, University College London, United Kingdom. 6. Institute for Infection and Immunity, St. George's University of London, London SW17 0RE, United Kingdom.
Abstract
OBJECTIVES: Detailed information regarding treatment practices and outcomes of MDR-TB treatment in the UK is required as a baseline for care improvements. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.
OBJECTIVES: Detailed information regarding treatment practices and outcomes of MDR-TB treatment in the UK is required as a baseline for care improvements. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.
Authors: Miranda G Loutet; Jennifer A Davidson; Tim Brown; Martin Dedicoat; H Lucy Thomas; Maeve K Lalor Journal: Emerg Infect Dis Date: 2018-03 Impact factor: 6.883
Authors: Helen R Stagg; Ibrahim Abubakar; Colin Nj Campbell; Andrew Copas; Marcia Darvell; Robert Horne; Karina Kielmann; Heinke Kunst; Mike Mandelbaum; Elisha Pickett; Alistair Story; Nicole Vidal; Fatima B Wurie; Marc Lipman Journal: BMJ Open Date: 2019-12-17 Impact factor: 2.692