Outcome of multi-drug-resistant tuberculosis in France - A nationwide case-control study

The factors related to the outcome of 51 cases of multi-drug-resistant tube rculosis (MDR-TB) reported in 1994 to the French National Reference Center were retrospectively analyzed. The patients (median age, 45 yr) were mainly male (75%), foreign-born (63%), and had pulmonary involvement (95%). Sixte en percent were human immunodeficiency virus (HIV)-coinfected. The number o f drugs to which the Mycobacterium tuberculosis isolates were susceptible w as four. Only 82% of the patients have been hospitalized at any time (media n duration, 33 d). Five patients (9%) received no antituberculosis drugs, a lthough three had drug susceptibility results, indicating that two or more active drugs were available; 46 (91%) received drugs, including 37 who rece ived two or more active drugs. Among the nine cases who received only one a ctive drug, three had drug susceptibility results, indicating that two or m ore active drugs were available. By December 1996, 10 patients were lost be fore treatment completion, 24 had treatment failure, and 17 had a favorable outcome. The median survival time was 31 mo. Factors related to a poorer o utcome were HIV-coinfection (hazard ratio [HR] = 41), treatment with less t han two active drugs (HR = 9.9), and MDR status knowledge at the time of di agnosis (HR = 3.3). The country of birth was not associated with a poorer o utcome. The management and outcome of MDR-TB in France has to be improved. A solution would be to develop a specialized unit or team for the treatment of MDR-TB, as recommended by the World Health Organization (WHO).