Treatment outcomes and relapses of pulmonary tuberculosis in Lazio, Italy, 1999-2001: a six-year follow-up study

Objectives: The aim of this study was to enhance tuberculosis (TB) treatment outcome monitoring by linking diverse surveillance systems and estimating treatment outcomes including relapse. Methods: Tuberculosis treatment was surveyed in the Lazio region (Italy) from 1999 to 2001; a sixyear follow-up of notified cases was undertaken to detect relapses. The results were analyzed as a population-based case-control study comparing each unsuccessful outcome and relapse with eligible controls. Results: Of the 974 patients who entered the survey, 805 (82.6%) had complete treatment evaluations; 398 (49.4%) had a successful outcome, 401 (49.8%) had an unsuccessful outcome, and six developed chronic TB. Death was associated with age >64 years (OR 5.9; 95% CI 3.1-11.2), mate gender (OR 2.1; 95% CI 1.0-4.4), and using second-line drugs (OR 2.3; 95% CI 1.0-5.4). Treatment failure was associated with previous treatment (OR 3.0; 95% CI 1.4-6.7) and being mate, being foreign born (OR 6.6; 95% CI 2.1-21.2), receiving second-tine drugs (OR 7.4; 95% CI 1.8-29.5), and receiving modified therapy (OR 5.1; 95% CI 1.7-14.9). Relapses after successful outcomes were detected in 5.5%, for which the strongest predictor was having extrapulmonary lesions (OR 22.8; 95% CI 1.8-287.3). Conclusions: Linking our survey data to other surveillance systems improved the mortality estimates and detected a high rate of relapse. Having received previous treatment and being a foreigner were independent determinants of treatment failure, suggesting that both acquired and primary drug resistance affect TB patients in Lazio. (C) 2008 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.