Figures
- FIGURE 1
Steps in identifying multidrug-resistant tuberculosis (MDR-TB) cases with treatment started in Finland in 2007–2016. NIDR: National Infectious Diseases Register; XDR: extensively drug-resistant. #: culture-negative cases with diagnoses based on radiology as well as 1) a positive nucleic acid amplification test result with rifampicin resistance and 2) a Finnish-born child with interferon-γ release assay (IGRA) positivity and a known exposure to MDR-TB; ¶: strains resistant to rifampicin and isoniazid; +: MDR-TB with additional resistance to any fluoroquinolone or injectable drug; §: MDR-TB with additional resistance to at least one fluoroquinolone and one injectable agent.
- FIGURE 2
Concordance of the phenotypic and genotypic (whole-genome sequencing) drug susceptibility testing results of the sequenced isolates (n=45).
Tables
- TABLE 1
Risk factors for non-successful outcome among multidrug-resistant (MDR) tuberculosis cases diagnosed and treatment started in Finland in 2007–2016
Variable All Successful Non-successful Univariate OR (95% CI) Univariate p-value Multivariate OR (95% CI) Multivariate p-value Subjects 47 35 12 Age years, median 34 30 38.5 Age/1 year 1.0 (0.99–1.05) 0.25 1.0 (0.96–1.05) 0.85 Sex Male 29 22 (75.9) 7 (24.1) Ref Ref Female 18 13 (72.2) 5 (27.8) 1.2 (0.3–4.4) 0.76 4.6 (0.79–48.8) 0.09 Origin Foreign 33 29 (87.9) 4 (12.1) Ref Ref Finnish 14 6 (42.9) 8 (57.1) 8.6 (2.2–39.0) 0.002 12.8 (2.0–142.9) 0.006 Site of disease Extrapulmonary 9 8 (88.9) 1 (11.1) Ref Ref Pulmonary 38# 27 (71.1) 11 (28.9) 2.4 (0.4–24.1) 0.33 1.5 (0.2–22.1) 0.71 Resistance MDR 43 35 (81.4) 8 (18.6) Ref Ref XDR 4 0 (0) 4 (100) 37.6 (3.5–5167.1) 0.001 62.3 (2.8–12 291.9) 0.006 Immunocompromised¶ No 40 30 (75.0) 10 (25.0) Ref Ref Yes 7 5 (71.4) 2 (28.6) 1.3 (0.2–6.3) 0.77 3.1 (0.38–27.0) 0.28 Data are presented as n or n (%), unless otherwise stated. Ref: reference; XDR: extensively drug-resistant. #: concomitant extrapulmonary tuberculosis n=8 out of 38 (21.1%); ¶: HIV (n=2), immunosuppressive medication (n=4), uncontrolled diabetes mellitus type 1 (n=1).
- TABLE 2
Multidrug-resistant tuberculosis (MDR-TB) treatment data for the 43 cases diagnosed and treated in Finland, 2007–2016#
Cases, n (%) Duration, median (IQR) Adverse events, n (%) Drugs, median (IQR) Injectable drug¶ 39 (90.7) 6.2 (5.2–7.4) months 22 (56.4) Linezolid 38 (88.4) 9.6 (5.6–14.8) months 26 (68.4) Fluoroquinolone+ 40 (93.0) 23.3 (15.8–24.8) months 10 (25.0) Clofazimine 23 (53.5) 12.3 (5.6–21.1) months 2 (8.7) Bedaquiline§ 5 (11.6) 5.9 (4.5–15.6) months 0 (0) Duration of effective MDR-TB treatment 23.8 (17.8–25.8) months Adverse event for any drug 38 (88.4) Number of drugs in intensive phase 6 (5–6) Number of drugs in continuation phase 4 (4–5) Duration of hospitalisation 50 (38–108) days Cases with all MDR-TB medicines paused 14 (32.6) Duration of pauses for cases with pauses in medication 9.0 (5.5–14.0) days DOT used 42 (97.7) IQR: interquartile range; DOT: directly observed treatment. #: cases that received only standard tuberculosis treatment with first-line drugs (n=1) or left Finland during MDR-TB treatment (n=3) were excluded; ¶: amikacin (n=37), streptomycin (n=2), non-recipient of an injectable drug due to drug resistance (n=3) and due to young age (n=1); +: non-recipient of fluoroquinolone due to drug resistance (n=3); §: extensively drug-resistant (n=3), pre-extensively drug-resistant (n=1), MDR (n=1).
- TABLE 3
Treatment outcomes for multidrug-resistant tuberculosis cases in Finland by different definitions, 2007–2016
Outcome Cases, n (%) Treatment outcome (WHO/ECDC)# Cured 19 (40.4) Treatment completed 16 (34.0) Failed 0 (0) Lost to follow-up 6 (12.8) Died 3 (6.4) Not evaluated 3 (6.4) Treatment outcome for pulmonary cases (TBNET)¶ Cured 20 (52.6) Failed 1 (2.6) Lost to follow-up 1 (2.6) Died 3 (7.9) Undeclared 13 (34.2) WHO: World Health Organization; ECDC: European Centre for Disease Prevention and Control; TBNET: Tuberculosis Network European Trials group. #: outcome assessed for all multidrug-resistant cases (n=47); ¶: outcome assessed for pulmonary multidrug-resistant cases only (n=38).
Supplementary Material
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Supplementary material 00214-2022.SUPPLEMENT
