Risk factors for treatment failure in multidrug resistant tuberculosis in Tunisia: An analytic study

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Published Feb 11, 2024
https://doi.org/10.62438/tunismed.v102i1.4521
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Vol. 102 No. 1 (2024): Tunis med jan 2024

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Fatma Tritar
Pulmonary department (C), Abderrahman Mami Hospital, Ariana, Faculty of Medicine of Tunis ,University of Tunis El Manar, Tunis, Tunisia
Soumaya Ben Saad
Pulmonary department (C), Abderrahman Mami Hospital, Ariana, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
Mariem Ferchichi
Pulmonary department (C), Abderrahman Mami Hospital, Ariana, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
Amani Ben Mansour
Pulmonary department (C), Abderrahman Mami Hospital, Ariana, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
Azza Slim
Pulmonary department (C), Abderrahman Mami Hospital, Ariana, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
Othmen Naffati
Pulmonary department, Menzel Bourguiba Hospital, Bizerte,Tunisia
Hedia Bellali
Department of Epidemiology. Habib Thameur Hospital, Tunis. Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
Leila Slim
Bacteriology department, Abderrahman Mami Hospital, Ariana. Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
Hafaoua Daghfous
Pulmonary department (C), Abderrahman Mami Hospital, Ariana, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia

Abstract

Introduction-Aim:


The emergence of multidrug resistant tuberculosis (MDR-TB) is a threat to global public health. The aim of our study was to determine risk factors for treatment failure in MDR-TB.


Methods:


Retrospective study conducted between January 2000 and March 2019 including patients with MDR-TB. Characteristics of patients with therapeutic failure were compared to cured ones. Logistic regression analysis was used to identify risk factors for treatment failure.


Results:


Our study included 140 patients aged of 42±13 years (18-80).  Fifty-seven percent of patients had treatment success and 12% had treatment failure. In multivariate logistic regression analysis, treatment failure was associated with age over 45 years (OR=1.05; 95%CI, 1.024-7.736;p=0.014), primary education level and illiteracy (OR=5.022; 95%CI, 1.316-19.161;p=0,018), history of incarceration (OR=3.291; 95%CI, 1.291-21.083;p=0.016), undernutrition (OR=4.544; 95%CI, 2.304-54.231;p=0,027), extensive TB (OR=6.406; 95%CI, 1.761-23.922; p=0.038), initial high grade positive smears (OR=1.210; 95%CI, 1.187-32.657; p=0.045), positive smear culture at 90 days of treatment (OR=6.871, 95%CI, 3.824-23.541; p=0.003), poor adherence (OR=6.110; 95%CI, 2.740-12.450; p=0.021) and occurrence of psychiatric adverse events (OR=3.644 95%CI, 2.560- 27.268; p=0.041).


Conclusion:


Therapeutic education, nutritional and psychological support and close follow-up are strongly recommended to optimize the prognosis of MDR-TB.

Keywords:

mycobacterium tuberculosis, susceptibility test, second-line drug, Prognosis, epidemiology, Tunisia, North Africa

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