A registry-based cohort study of pulmonary tuberculosis treatment outcomes in Istanbul, Turkey

The aim of this study is to evaluate the treatment outcomes and identify factors associated with adverse tuberculosis treatment outcomes for bacteriologically confirmed pulmonary tuberculosis. Treatment outcomes of pulmonary tuberculosis were evaluated retrospectively among 11,186 smearand/ or culture-positive patients treated between 2006 and 2009 in Istanbul, Turkey. Adverse treatment outcomes were identified in 1,010 (9.0z) patients including death (1.8z), treatment default (6.1z), and treatment failure (1.1z). Factors associated with adverse treatment outcomes included being born abroad (odds ratios [OR], 5.38; 95zconfidence intervals [CI], 3.67-7.91), history of tuberculosis treatment (OR, 3.77; 95z CI, 3.26-4.36), age> 65 years (OR, 2.79; 95z CI, 2.21-3.53), and male gender (OR, 1.91; 95z CI, 1.59-2.27). Death was most strongly associated with age > 65 years (OR, 45.1; 95z CI, 27.0-75.6), followed by treatment default with history of interrupted treatment (OR, 11.6; 95z CI, 8.94-15.1), and treatment failure with prior history of treatment failure (OR, 17.1; 95z CI, 6.97-41.6). Multidrug resistance was strongly associated with adverse treatment outcomes (OR, 10.8; 95zCI, 8.02-14.6). Age > 65 years, male sex, being born abroad, and history of treatment failure were found to be risk factors for adverse treatment outcomes. Hence, patients with any of these characteristics should be carefully monitored and treated aggressively.