Predictors of mortality in multidrug-resistant tuberculosis patients from Brazilian reference centers, 2005 to 2012

Objectives: To determine the main predictors of death in multidrug-resistant (MDRTB) patients from Brazil. Design: Retrospective cohort study, a survival analysis of patients treated between 2005 and 2012. Results: Of 3802 individuals included in study, 64.7% were men, mean age was 39 (1-93) years, and 70.3% had bilateral pulmonary disease. Prevalence of human immunodeficiency virus (HIV) was 8.3%. There were 479 (12.6%) deaths. Median survival time was 1452 days (4 years). Factors associated with increased risk of death were age greater than or equal to 60 years (hazard rate [HR] =1.6, confidence interval [CI] = 1.15-2.2), HIV co-infection (HR = 1.46; CI =1.05-1.96), XDR resistance pattern (HR= 1.74, CI =1.05-2.9), beginning of treatment after failure (HR =1.72, CI =1.27-2.32), drug abuse (HR =1.64, CI =1.22-2.2), resistance to ethambutol (HR= 1.30, CI =1.06-1.6) or streptomycin (HR= 1.24, CI =1.01-1.51). Mainly protective factors were presence of only pulmonary disease (HR = 0.57, CI =0.35-0.92), moxifloxacin use (HR= 0.44, CI = 0.25-0.80), and levofloxacin use (HR = 0.75; CI = 0.60-0.94). Conclusion: A more comprehensive approach is needed to manage MDRTB, addressing early diagnostic, improving adhesion, and comorbidities, mainly HIV infection and drug abuse. The latest generation quinolones have an important effect in improving survival in MDRTB. (C) 2018 Sociedade Brasileira de Infectologia. Published by Elsevier Editora Ltda.