High mortality during tuberculosis retreatment at a Ghanaian tertiary center: a retrospective cohort study.

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ID: 75566
2019
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Abstract
High mortality among individuals receiving retreatment for tuberculosis (RT-TB) persists, although reasons for these poor outcomes remain unclear.We retrospectively reviewed 394 RT-TB patients diagnosed between January 2010 and June 2016 in Accra, Ghana.Of RT-TB patients, 161 (40.9%) were treated empirically (negative/absent smear, culture or Xpert), of whom 30.4% (49/161) had only extrapulmonary TB signs or symptoms. Mortality during treatment was 19.4%; 15-day mortality was 10.8%. In multivariable proportional hazards regression, living with HIV (aHR=2.69 [95 CI: 1.51, 4.80], p<0.01) and previous loss-to-follow up (aHR=8.27 (95 CI: 1.10, 62.25), p=0.04) were associated with mortality, while drug susceptibility testing (DST, aHR=0.36 (95 CI: 0.13, 1.01), p=0.052) was protective. Isoniazid resistance was observed in 40% (23/58 tested) and rifampin resistance in 19.1% (12/63 tested).High rates of extrapulmonary TB and smear/culture negative disease highlight the barriers to achieving DST-driven RT-TB regimens and the need for improved diagnostics. Our finding of poly-drug resistance in rifampin-susceptible cases supports access to comprehensive first line DST. Additionally, interventions to reduce mortality, especially in HIV co-infected RT-TB patients, are urgently needed.
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bouton2019highthe Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors Bouton, Tara Catherine;Forson, Audrey;Kudzawu, Samuel;Zigah, Francisca;Jenkins, Helen;Bamfo, Tsigereda Danso;Carter, Jane;Jacobson, Karen;Kwara, Awewura;
Journal The Pan African medical journal
Year 2019
DOI
10.11604/pamj.2019.33.111.18574
URL
Keywords
recurrent tuberculosis drug resistant tuberculosis previously treated tuberculosis

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