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Pulmonary resection in the treatment of multidrug-resistant tuberculosis: A case series.

Abstract Multidrug-resistant (MDR) and extensive drug-resistant (XDR) tuberculosis (TB) are significant health problems throughout the world. Although the main treatment is medical, adjunctive surgical resection may increase the chance of cure in selected patients with MDR-TB or XDR-TB. This study aimed to present a case series of patients who underwent surgical resection for MDR-TB.Between March 2008 and November 2011, surgical resection was performed on 54 patients including 34 with MDR-TB and 20 with XDR-TB at the Departments of Surgery of Shanghai Public Health Clinical Center (Shanghai), Henan Chest Hospital (Henan), and Anhui Chest Hospital (Henan). Preoperative sputum smear samples were positive for 28 patients and sputum quantitative polymerase chain reaction was positive for 32. Patients were treated according to a standard therapy protocol for a mean of 4.2 months before the operation. The variables that affected treatment outcomes were identified through multivariate regression analysis.Fifty-four patients were operated for MDR-TB with localized disease usually complicated by cavity formation or destroyed lung. Thirty-seven were males and 17 were females. Median age was 37.8 (range, 20-75) years. Lobectomy was performed in 46 patients and pneumonectomy in 8. Muscle flaps were used in 36 of the patients with lobectomy and 8 with pneumonectomy. Various complications occurred in 6 (11.1%) patients, including bronchopleural fistula in 1 patient, bleeding in 2 patients, and prolonged air leak in 2 patients. A favorable outcome was achieved in 47 patients (87%) who underwent surgical resection. Higher body mass index (BMI) was associated with better outcome (odds ratio = 0.537, 95% confidence interval: 0.310-0.928, P = .026).Patients with MDR-TB had good treatment outcomes after adjunctive pulmonary resection, and with few complications. Higher BMI was related to a favorable outcome.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 29390307
OWN - NLM
STAT- MEDLINE
DCOM- 20180212
LR  - 20180212
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 50
DP  - 2017 Dec
TI  - Pulmonary resection in the treatment of multidrug-resistant tuberculosis: A case 
      series.
PG  - e9109
LID - 10.1097/MD.0000000000009109 [doi]
AB  - Multidrug-resistant (MDR) and extensive drug-resistant (XDR) tuberculosis (TB)
      are significant health problems throughout the world. Although the main treatment
      is medical, adjunctive surgical resection may increase the chance of cure in
      selected patients with MDR-TB or XDR-TB. This study aimed to present a case
      series of patients who underwent surgical resection for MDR-TB.Between March 2008
      and November 2011, surgical resection was performed on 54 patients including 34
      with MDR-TB and 20 with XDR-TB at the Departments of Surgery of Shanghai Public
      Health Clinical Center (Shanghai), Henan Chest Hospital (Henan), and Anhui Chest 
      Hospital (Henan). Preoperative sputum smear samples were positive for 28 patients
      and sputum quantitative polymerase chain reaction was positive for 32. Patients
      were treated according to a standard therapy protocol for a mean of 4.2 months
      before the operation. The variables that affected treatment outcomes were
      identified through multivariate regression analysis.Fifty-four patients were
      operated for MDR-TB with localized disease usually complicated by cavity
      formation or destroyed lung. Thirty-seven were males and 17 were females. Median 
      age was 37.8 (range, 20-75) years. Lobectomy was performed in 46 patients and
      pneumonectomy in 8. Muscle flaps were used in 36 of the patients with lobectomy
      and 8 with pneumonectomy. Various complications occurred in 6 (11.1%) patients,
      including bronchopleural fistula in 1 patient, bleeding in 2 patients, and
      prolonged air leak in 2 patients. A favorable outcome was achieved in 47 patients
      (87%) who underwent surgical resection. Higher body mass index (BMI) was
      associated with better outcome (odds ratio = 0.537, 95% confidence interval:
      0.310-0.928, P = .026).Patients with MDR-TB had good treatment outcomes after
      adjunctive pulmonary resection, and with few complications. Higher BMI was
      related to a favorable outcome.
CI  - Copyright (c) 2017 The Authors. Published by Wolters Kluwer Health, Inc. All
      rights reserved.
FAU - Wang, Lin
AU  - Wang L
AD  - Department of Thoracic Surgery, Shanghai Public Health Clinical Center.
FAU - Xia, Fan
AU  - Xia F
AD  - Department of Tuberculosis, The Eighty-Fifth Hospital of PLA.
FAU - Li, Feng
AU  - Li F
AD  - Scientific Research, Shanghai Public Health Clinical Center.
FAU - Qian, Xueqin
AU  - Qian X
AD  - Department of Clinical Laboratory, Shanghai Public Health Clinical Center,
      Shanghai.
FAU - Zhu, Yijun
AU  - Zhu Y
AD  - Department of Thoracic Surgery, Shanghai Public Health Clinical Center.
FAU - Chen, Hui
AU  - Chen H
AD  - Department of Thoracic Surgery, Shanghai Public Health Clinical Center.
FAU - Bian, Aoao
AU  - Bian A
AD  - Department of Surgery, Suzhou Fifth People's Hospital, Suzhou.
FAU - Wang, Jun
AU  - Wang J
AD  - Department of Thoracic Surgery, Shanghai Public Health Clinical Center.
FAU - Zhang, Min
AU  - Zhang M
AD  - Department of Clinical Laboratory, Shanghai Public Health Clinical Center,
      Shanghai.
FAU - Li, Hongwei
AU  - Li H
AD  - Department of Thoracic Surgery, Shanghai Public Health Clinical Center.
FAU - Han, Jiafu
AU  - Han J
AD  - Department of Thoracic Surgery, Shanghai Public Health Clinical Center.
FAU - Jiang, Nan
AU  - Jiang N
AD  - Department of Surgery, Anhui Chest Hospital (Henan), Zhengzhou.
FAU - Xu, Ning
AU  - Xu N
AD  - Department of Surgery, Anhui Chest Hospital (Anhui), Hefei, China.
FAU - Song, Yanzheng
AU  - Song Y
AD  - Department of Thoracic Surgery, Shanghai Public Health Clinical Center.
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
SB  - AIM
SB  - IM
MH  - Adult
MH  - Aged
MH  - Extensively Drug-Resistant Tuberculosis/*surgery
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Pneumonectomy
MH  - Retrospective Studies
MH  - Treatment Outcome
MH  - Tuberculosis, Multidrug-Resistant/*surgery
MH  - Tuberculosis, Pulmonary/*surgery
EDAT- 2018/02/03 06:00
MHDA- 2018/02/13 06:00
CRDT- 2018/02/03 06:00
PHST- 2018/02/03 06:00 [entrez]
PHST- 2018/02/03 06:00 [pubmed]
PHST- 2018/02/13 06:00 [medline]
AID - 10.1097/MD.0000000000009109 [doi]
AID - 00005792-201712150-00057 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Dec;96(50):e9109. doi: 10.1097/MD.0000000000009109.