Clinical analysis of cases with multidrug-resistant tuberculosis--inpatients at National Hospitals in Kyushu between 1998 and 2003

Clinical analysis of inpatients with multidrug-resistant tuberculosis in Kyushu. Clinical analysis of fifty-six patients with multidrug-resistant tuberculosis, who were admitted between 1998 and 2003, at 12 national hospitals in Kyushu was performed retrospectively. The average age was 62.1 +/- 18.6 years, with an age range of 21 to 95 years. There were 44 males and 12 females. Seven of the 14 patients, who were under 49 years old, had not received treatment previously. Twenty nine patients had underlying diseases, which included 10 (17.9%) diabetes mellitus, 5 (8.9%) hepatic disease, and 4 (7.1%) renal insufficiency. Clinical classification of the cases were 54 pulmonary and 2 extrapulmonary tuberculosis. There were 41 (75.9%) bilateral lesions of the lung. In 8 cases, strains were resistant to only 2 drugs (isoniazid, rifampicin). In 27 cases, strains were resistant to at least 5 drugs. The prognosis was as follows: In 27 patients who were resistant to at least 5 drugs, six patients (22.2%) converted to negative on culture and 10 patients (37.0%) died. In 29 patients who were resistant to less than 5 drugs, seventeen patients (58.6%) converted to negative on culture and 6 patients (20.7%) died. Surgical operation was performed in only 7 cases. The sputum smear and culture of 2 surgical patients, who had poor control of diabetes mellitus, became positive thereafter. The other 5 surgical patients were in remission with negative cultures. CONSIDERATION: Half of the patients who were under 49 years old had not received treatment previously. More than half of the patients had underlying diseases. Patients, who were resistant to at least 5 drugs showed a lower bacteriological negative conversion-rate and higher death rate than patients who were resistant to less than 5 drugs.