J R Francis1, P Manchikanti2, C C Blyth3, J Denholm4, C Lowbridge5, C Coulter6, E Donnan6, R Stapledon7, V L Krause8, J Waring9. 1. Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Department of Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory. 2. Department of Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory. 3. Department of Infectious Diseases, Princess Margaret Hospital for Children, Perth, Western Australia, Telethon Kids Institute, University of Western Australia, Perth, Western Australia. 4. Victorian Tuberculosis Program, Melbourne Health, Melbourne, Victoria. 5. New South Wales Tuberculosis Program, Sydney, New South Wales. 6. Communicable Diseases Branch, Queensland Health, Brisbane, Queensland. 7. South Australia Tuberculosis Services, Adelaide, South Australia. 8. Northern Territory Centre for Disease Control, Darwin, Northern Territory. 9. Western Australia Tuberculosis Control Centre, Perth, Western Australia, Australia.
Abstract
OBJECTIVE: To describe the epidemiology and outcomes of multidrug-resistant tuberculosis (MDR-TB) diagnosed in Australia between 1998 and 2012. DESIGN: A retrospective review was undertaken involving all patients with laboratory-confirmed MDR-TB notified in Australia between 1998 and 2012 inclusive. Demographic, clinical and laboratory features are described. Clinical outcomes were defined according to World Health Organization definitions of treatment success (cure and treatment completion), treatment failure, death, loss to follow-up (including transfer out), or not evaluated at treatment completion. RESULTS: A total of 244 cases of MDR-TB were diagnosed in Australia during the study period, representing 1.4% of all TB cases notified. The majority were born outside Australia, including one third in Papua New Guinea. Of those with treatment outcome data available, treatment success was demonstrated in 81%. Treatment success was positively associated with use of a second-line injectable agent. Those born in Papua New Guinea were less likely to achieve treatment success. CONCLUSION: MDR-TB is uncommon in Australia. The large number of cases born in Papua New Guinea, and the poorer outcomes in this cohort, represent challenges with cross-border management of MDR-TB in the Torres Strait. Australia has an ongoing role in the prevention and management of MDR-TB locally and in the region.
OBJECTIVE: To describe the epidemiology and outcomes of multidrug-resistant tuberculosis (MDR-TB) diagnosed in Australia between 1998 and 2012. DESIGN: A retrospective review was undertaken involving all patients with laboratory-confirmed MDR-TB notified in Australia between 1998 and 2012 inclusive. Demographic, clinical and laboratory features are described. Clinical outcomes were defined according to World Health Organization definitions of treatment success (cure and treatment completion), treatment failure, death, loss to follow-up (including transfer out), or not evaluated at treatment completion. RESULTS: A total of 244 cases of MDR-TB were diagnosed in Australia during the study period, representing 1.4% of all TB cases notified. The majority were born outside Australia, including one third in Papua New Guinea. Of those with treatment outcome data available, treatment success was demonstrated in 81%. Treatment success was positively associated with use of a second-line injectable agent. Those born in Papua New Guinea were less likely to achieve treatment success. CONCLUSION: MDR-TB is uncommon in Australia. The large number of cases born in Papua New Guinea, and the poorer outcomes in this cohort, represent challenges with cross-border management of MDR-TB in the Torres Strait. Australia has an ongoing role in the prevention and management of MDR-TB locally and in the region.