Long-term mortality of patients with tuberculous meningitis in New York city: A cohort study

Christopher Vinnard, Liza King, Sonal Munsiff, Aldo Crossa, Kentaro Iwata, Jotam Pasipanodya, Douglas Proops, Shama Ahuja

Research output: Contribution to journalArticlepeer-review

38 Scopus citations

Abstract

Background. Tuberculous meningitis (TBM) is the most devastating clinical presentation of infection with Mycobacterium tuberculosis; delayed initiation of effective antituberculosis therapy is associated with poor treatment outcomes. Our objective was to determine the relationship between drug resistance and 10-year mortality among patients with TBM. Methods. We conducted a retrospective cohort study of 324 patients with culture-confirmed TBM, susceptibility results reported for isoniazid and rifampin, and initiation of at least 2 antituberculosis drugs, reported to the tuberculosis registry in New York City between 1 January 1992 and 31 December 2001. Date of death was ascertained by matching the tuberculosis registry with death certificate data for 1992-2012 from the New York Office of Vital Statistics. Human immunodeficiency virus (HIV) status was ascertained by medical records review, matching with the New York City HIV Surveillance registry, and review of cause of death. Results. Among 257 TBM patients without rifampin-resistant isolates, isoniazid resistance was associated with mortality after the first 60 days of treatment when controlling for age and HIV infection (adjusted hazard ratio, 1.94 [95% confidence interval, 1.08- 3.94]). Death occurred before completion of antituberculosis therapy in 63 of 67 TBM patients (94%) with rifampin-resistant disease. Conclusions. Among patients with culture-confirmed TBM, we observed rapid early mortality in patients with rifampin-resistant isolates, and an independent association between isoniazid-resistant isolates and death after 60 days of therapy. These findings support the continued evaluation of rapid diagnostic techniques and the empiric addition of second-line drugs for patients with clinically suspected drug-resistant TBM.

Original languageEnglish (US)
Pages (from-to)401-407
Number of pages7
JournalClinical Infectious Diseases
Volume64
Issue number4
DOIs
StatePublished - Feb 15 2017

All Science Journal Classification (ASJC) codes

  • Microbiology (medical)
  • Infectious Diseases

Keywords

  • Drug resistance
  • Multidrug resistance
  • Treatment outcome
  • Tuberculosis
  • Tuberculous meningitis

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