PLoS ONE (Jan 2022)

Long term outcomes of patients with tuberculous meningitis: The impact of drug resistance.

  • Emily E Evans,
  • Teona Avaliani,
  • Mariam Gujabidze,
  • Tinatin Bakuradze,
  • Maia Kipiani,
  • Shorena Sabanadze,
  • Alison G C Smith,
  • Zaza Avaliani,
  • Jeffrey M Collins,
  • Russell R Kempker

DOI
https://doi.org/10.1371/journal.pone.0270201
Journal volume & issue
Vol. 17, no. 6
p. e0270201

Abstract

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BackgroundLittle is known about the impact of drug-resistance on clinical outcomes among patients with tuberculosis meningitis (TBM).MethodsA retrospective cohort study among patients treated for TBM in Tbilisi, Georgia. We performed medical chart abstraction to collect patient data. Long-term vital status was assessed using the Georgia National Death Registry. We utilized a Cox proportional-hazards model to evaluate the association of drug-resistance and mortality.ResultsAmong 343 TBM suspects, 237 had a presentation consistent with TBM. Drug resistance was suspected (n = 5) or confirmed (n = 31) in 36 patients including 30 with multidrug- or rifampin-resistance and 6 with isoniazid-resistance. Thirty-four patients had HIV. The median follow-up time was 1331 days (IQR, 852-1767). Overall, 73 of 237 (30%) people died with 50 deaths occurring during and 23 after treatment. The proportion of death was higher among patients with drug-resistant vs. drug-susceptible disease (67% vs. 24%, pConclusionsMortality was high among patients with drug-resistant TBM with many deaths occurring post treatment. More effective treatment options are urgently needed for drug-resistant TBM.