Characteristics and Treatment Outcomes of Patients with Multidrug-Resistant Tuberculosis at Abbassia Chest Hospital: A Tertiary Chest Facility in Cairo, Egypt
Authors: Nofal Ibrahim , AbdelHalim Hesham Atef , Almaraghy Ashraf Abbass , Awad Amr Mohammed , Farrag Mohamed Ali 
Published: September 2024

Abstract

Background: Multi-drug-resistant tuberculosis (MDR-TB) is a considerable health concern, with a significant number of cases diagnosed in the study period. This study aims to determine the magnitude of drug-resistant tuberculosis in patients admitted to Abbassia chest hospital by describing the characteristics and features of patients, the pattern of drug resistance, and their treatment outcomes. Additionally, the study measured the incidence of poor prognosis in this cohort and evaluated the risk factors implicated in poor outcomes.
Methods: A retrospective cohort study was conducted on patients admitted to the MDR unit at Abbassia Chest Hospital. The study included 121 patients who had a confirmed diagnosis of tuberculosis (TB) through direct microscopic examination of sputum smear for acid-fast bacilli, as well as the use of a combination of microbiological culture and sensitivity test for TB bacilli and molecular diagnosis using GeneXpert methods. The patient data was collected from hospital records for further statistical analysis.
Results: The mean age of MDR-TB patients was 40 years old, and more than 2/3 of them were married males, 67.77% and 75.21%, respectively. The most prevalent associated risk factors with MDR-TB were a history of receiving TB medication, being a current smoker, and having contact with MDR-TB patients. More than 90% of patients were resistant to Cycloserin, Ethionamide, Pyrazinamide, and levofloxacin. Additionally, around 71.9% of patients showed resistance to Amoxicillin. However, less than a third of the patients resisted INH, PAS, and Kanamycin. Sputum conversion was reported in 95.04% of patients, the minimum time of conversion was one month, and the maximum time was six months. Moreover, successful medication was recorded in 84.3% of patients. Medication side effects were recorded in 45.45% of patients; the most frequent side effect was hyperuricemia (28.1%), followed by gastritis and ototoxicity (11.57%). Adversely, three patients died during treatment; the three patients were males with different comorbidities (DM, HTN, and IHD); the cause of death was far away from the side effects of medication, as none of them complained of associated side effects. Comorbidity was significantly associated with poor prognosis, especially HTN and IHD, p=0.05, 0.01, and 0.01, respectively. Patients who demonstrated resistance to Kanamycin and levofloxacin had a significantly poor prognosis, with a statistical significance of p=0.05. Only patients with poor prognosis characterized by a lower sputum conversion rate, 68.42%, with prolonged time to convert from positive to negative; (2.21±1.44) months, p=0.001 and 0.04, respectively. Furthermore, the recording of medication side effects did not link to poor prognosis. Hence, 50% of the successful group had reported different side effects, opposite to 21.05% of the poor prognosis group, p=0.02 adjusting for the age and sex of patients revealed that MDR-TB patients with IHD had a 15 times higher likelihood of a poor prognosis, with an odds ratio of 15.34 and a p-value of 0.02. Additionally, for every one-month delay in sputum conversion, the likelihood of poor prognosis doubled, with an odds ratio of 1.63 and a p-value of 0.03.
Conclusion: While successful medication outcomes were achieved in most of MDR-TB patients, certain factors such as comorbidities (particularly HTN and IHD), drug resistance patterns, and delayed sputum conversion significantly influenced the bad prognosis.