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Abstract
Background: Extensively drug-resistant tuberculosis (XDR-TB) has recently emerged as a global public health problem. The objective of this study was to investigate the clinical characteristics, management and outcomes of human immunodeficiency virus-negative patients with XDR-TB at a specialist TB hospital in Shanghai, China. Methods: From July 2007 to June 2009 we analyzed TB patients with culture-proven XDR-TB at a specialist TB hospital in Shanghai. Results: Among 1156 TB cases, all culture-positive for Mycobacterium tuberculosis complex, 494 cases (42.7%) were classified as MDR-TB; 126 cases (10.9%) were XDR-TB. At least 3 lung fields were involved in 90.5% of XDR-TB patients and in 80.7% of other MDR-TB patients (p = 0.008). Of the XDR-TB cases, 40.5% were complicated by diabetes and other diseases, significantly higher compared with the other MDR-TB cases (p = 0.002). The rates of resistance to all drugs except isoniazid and rifampicin were significantly higher in patients with XDR-TB than in patients with other MDR-TB (p < 0.001). Treatment failure was more common in patients with XDR-TB than in those with other MDR-TB (p < 0.001), whereas the mortality and default rates did not differ significantly. Conclusions: The prevalence of XDR-TB is high in some areas of China. The clinical treatment outcome for XDR-TB is usually very poor.
Acknowledgements
We acknowledge the outstanding contributions of the technicians and nursing staff at Shanghai Pulmonary Hospital. We also express our thanks to Fang Yuanyuan and Lv Yan for their time and effort in the data collection and patient follow-up. Financial support was provided by the Key Project of Chinese National Programs (grant No. 2009ZX 10003-017).
Declaration of interest: No conflicts for all authors.