Clinical Outcomes of Estonian Patients with Primary Multidrug-Resistant versus Drug-Susceptible Tuberculosis

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Abstract
Little is known about the clinical outcomes of patients with primary multidrug-resistant (MDR) tuberculosis. Clinical outcomes among 46 patients in Estonia with primary MDR tuberculosis and 46 patients with pansusceptible tuberculosis were compared. Patients with MDR tuberculosis were more likely than those with pansensitive tuberculosis to have treatment failure (odds ratio, 8.9; 95% confidence interval [CI], 3.0–26.3) after adjusting for medical problems and weeks of effective treatment, often with second-line drugs. Ten patients (22%) with MDR tuberculosis and 2 (4%) with susceptible tuberculosis died of tuberculosis (P = .03). MDR tuberculosis (hazard ratio [HR], 7.8; 95% CI, 1.6–37.4), number of medical problems (HR, 2.5; 95% CI, 1.5–4.4), and male sex (HR, 5.8; 95% CI, 1.1–29.6) were associated with death due to tuberculosis in multivariable analysis. Human immunodeficiency virus test results were negative for all 55 patients tested. These findings underscore the urgent need for increased attention to prevention and treatment of MDR tuberculosis globally.