Experience of Treating Patients With Multidrug-Resistant Tuberculosis at a Public Health Hospital in Boston.

Background: Management of patients with multidrug-resistant tuberculosis (MDR-TB) is challenging and resource intensive. We describe demographic/clinical characteristics, management, and outcomes of patients with MDR-TB in a designated TB unit in a public health hospital located in Boston, Massachusetts. Methods: Records of 42 patients treated for MDR-TB between 1993 and 2014 were reviewed. Data were extracted from paper/electronic medical records. Results: Forty-two patients were treated for MDR-TB between 1993 and 2014. The mean age was 41.9 years (17-78 years); 35 patients (83%) were foreign born. Thirty-three patients (78%) were diagnosed as having pulmonary TB, 5 (12%) as having extrapulmonary disease, and 4 (10%) as having both pulmonary and extrapulmonary TB. Thirty-six patients (86%) received an injectable agent; half received injectable therapy for 4 months or less. Fourteen (33%) received inhaled aminoglycosides. Mean time to culture conversion was 3.4 months. Thirty-three patients (79%) required admission to the inpatient unit for respiratory isolation, psychosocial reasons, or management of acute toxicities. Duration of treatment ranged from 10 to 29 months. All patients successfully completed therapy. There were no deaths. Conclusions: All patients demonstrated clinical improvement and culture conversion, where appropriate, without relapse. Despite variations in treatment regimens, a significant number of individuals were cured with less than the recommended 6 months of injectable therapy. Given the complexity of second-line drugs and associated toxicities, the treatment of MDR-TB should be reserved for those with experience in this area with the support of a strong public health infrastructure to aid in this endeavor. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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