A Survival Analysis of Successful and Poor Treatment Outcome Among Patients with Drug-Resistant Tuberculosis and the Associated Factors: A Retrospective Cohort Study

Putri Bungsu Machmud, Dwi Gayatri, Sudarto Ronoatmodjo


Background: Tuberculosis and its resistance are a major global health problem in the world. The increased incidence and mortality of tuberculosis in Indonesia remain a big public health issue especially in Jakarta Province. No published studies have focused on assessing the outcome treatment of tuberculosis resistance both in success and death. We aimed this study to assess the survival of cured and death outcomes as well as the determinant factors which might influence drugs resistant tuberculosis in Jakarta between 2010 and 2015. Methods: this study analyzed the national electronic tuberculosis register (e-TB Manager) of Jakarta province in 2010 to 2015. All adult patients who lived in Jakarta province and were diagnosed with multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) were eligible for the study. Kaplan Meier survival curve was used, together with log-rank test and Chi-Square (X2) test for descriptive analysis. Cox regression analysis helped determine the potential risk factors. Several risk factors were analyzed in this study, including age, gender, residency, HIV status, resistance status, and history of previous treatment. Results: we analyzed 553 samples in this study. The drug-resistant tuberculosis cases increased gradually from 2010 to 2015. Of all cases, 248 and 67 patients were cured and death, respectively. There was a difference in survival rate between patients diagnosed with MDR-TB and XDR-TB with successful treatment. Poor treatment outcome (death) among patients was predicted by age greater than 60 years old (HR 3.48; 95% CI 1.48 – 8.38, p-value = 0.004). Conclusion: there was a difference survival rates between success treatment (cured) and poor treatment outcome (death) during six years of observation. Age of patients is a single-predictor in survival of death. While, HIV status and resistance status were predictors in survival of cured.


MDR; XDR; Tuberculosis; Resistance; Survival analysis


World Health Organization. Global Tuberculosis Report 2018. France: WHO; 2018.

Wardhani AK. Penderita TBC di Jakarta terbanyak di Indonesia: ini penyebabnya. Tribun Jakarta: 2018. Cited on 31 Maret 2018.

Dintle Mogobe K, Ray S, Madzimbamuto F, et al. Non-citizens and maternal mortality in Botswana: a rights perspective. Int J Migration Health Soc Care. 2014;10:220-30.

Jakarta Health Office. Jakarta Health Profile 2017: Jakarta Health-Office; 2018. Cited on 2 July 2018.

Wardhani AK. Penderita TBC di Jakarta terbanyak di Indonesia. Tribun Jakarta 2018. Cited on 31 Maret 2018.

Lawn SD, Zumla AI. Tuberculosis. Lancet. 2011;378:57-72.

Weiss P, Chen W, Cook VJ, Johnston JC. Treatment outcomes from community-based drug resistsnt tuberculosis treatment programs: a systematic review and meta-analysis. BMC Infect Dis. 2014;14:1-9.

Gegia M, Winters N, Benedetti A, Soolingen DV, Menzies D. Treatment of isoniazid-resistant tuberculosis with first-line drgus: a systematic review and meta-analysis. Lancet Infect Dis. 2017;17:223-34.

Bernabe-Ortiz A, Carcamo CP, Sanchez JF, Rios J. Weight variation over time and its association with Tuberculosis treatment outcome: A longitudinal analysis. PLoS One. 2011;6.

Keshavjee S, Gelmanova IY, Farmer PE, et al. Treatment of exetensively drug-resistant tuberculosis in Tomsk, Russia: a restrospective cohort study. The Lancet. 2008;372:1403-9.

Duraisamy K, Mrithyunjayan S, Ghosh S, et al. Does alcohol consumption during multidrug-resistant tuberculosis treatment affect outcome? Annals Am Thorac Soc. 2014;11:712-8.

Sinshaw Y, Alemu S, Fekadu A, Gizachew M. Successful Tb treatment outcome and its associated factors among TB/HIV co-infected patients attending Gondar University Referral Hospital, Northwest Ethiopia: an institution based cross-sectional study. BMC Infect Dis. 2017;17:1-9.

Samuels JP, Sood A, Campbell JR, Khan FA, Johnston JC. Comorbidities and treatment outcomes in multidrug resistant tuberculosis: a systematic review and meta-analysis. Scientific Reports (Nature Publisher Group). 2018;8.

Feleke BE, Alene GD, Feleke TE, Motebaynore Y, Biadglegne F. Clinical response of tuberculosis patients, a prospective cohort study. PLOS ONE. 2018;13:1-11.

Moosazadeh M, Bahrampour A, Nasehi M, Khanjani N. Survival and predictores of death after successful treatment among smear positive tuberculosis: a cohort study. Int J Preventive Med. 2014;5.

Berhe G, Enquselassie F, Aseffa A. Treatment outcome of smear-positive pulmonary tuberculosis patients in Tigray Region, Northern Ethiopia. BMC Public Health. 2012;12:1-9.

Orenstein EW, Basu S, Shah NS, Andrews JR, Friedland GH, Moll AP, et al. Treatment outcomes among patients with multidrug-resistant tuberculosis:systematic review and meta-analysis. Lancet Infect Dis. 2009;9:153-61.

Tabarsi P, Chitsaz E, Baghaei P, et al. Impact of extensively drug-resistant tuberculosis on treatment outcome of multidrug-resistant tuberculosis patients with standardized regimen: report from Iran. Microbial Drug Resistance. 2010;16:81-6.

Alene KA, Yi H, Viney K, et al. Treatment outcomes of patients with multidrug-resistant and extensively drug resistant tuberculosis in Hunan Province, China. BMC Infect Dis. 2017;17:1-11.

Balabanova Y, Radiulyte B, Davidaviciene E, et al. Survival of drug resistant tuberculosis patients in Lithuania: retrospective national cohort study. BMJ Open Accessible Med Res. 2011;1:1-9.

Limenih YA, Workie DL. Survival analysis of time to cure on multi-drug resistance tuberculosis patients in Amhara region, Ethiopia. BMC Public Health. 2019;19:1-11.

Kigozi G, Engelbrecht M, Heunis C, Rensburg AJV. Household contact non-attendance of clinical evaluation for tuberculosis: a pilot study in a high burden district in South Africa. BMC Infect Dis. 2018;18:1-8.

Chida N, Ansari Z, Hussain H, et al. Determinants of default from tuberculosis treatment among patients with drug-susceptible tuberculosis in Karachi, Pakistan: A mixed methods study. PLOS ONE. 2015;10:1-14.

Yone EWP, Kuaban C, Kengne AP. HIV testing, HIV status and outcomes of treatment for tuberculosis in a major diagnosis and treatment centre in Yaounde, Cameroon: a retrospective cohort study. BMC Infect Dis. 2012;12:1-7.

Girum T, Tariku Y, Dessu S. Survival and treatment outcome of multidrug resistant tubeculosis (MDR-TB) among patients treated in Treatment Initiation Centers (TIC) in South Ethiopia: a retrospective cohort study. Annals Med Health Sci Res. 2017;7.

Walt Mvd, Lancaster J, Shean K. Tuberculosis case fatality and other causes of death among multidrug-resistant tuberculosis patients in a high HIV prevalence setting, 2000-2008, South Africa. PLOS ONE. 2016;11:1-9.

Satti H, McLaughlin MM, Hedt-Gauthier B, et al. Outcomes of multisrug-resistant tuberculosis treatment with early initiation of antiretroviral theraphy fir HIV co-infected patients in Lesotho. PLOS ONE. 2012;7:1-7.

Gandhi NR, Moll A, Sturm AW, et al. Extensively drug-resistant tuberculosis as a cause of death in patient co-infected with tuberculosis and HIV in a rural area of South Africa. Lancet. 2006;368:1575-80.

Jeon DS, Shin DO, Park SK, et al. Treatment outcome and mortality among patients with multidrug-resistant tuberculosis in tuberculosis hospital of the public sector. J Korean Med Sci. 2011;26:33-41.

Alemu A, Bitew ZW, Worku T. Poor treatment outcome and its predictors among drug-resistant tuberculosis patients in Ethiopia: A systematic review and meta-analysis. Int J Infect Dis. 2020;98:420-39.

Si Z-L, Kang L-L, Shen X-B, Zhou Y-Z. Adjuvant efficacy of nutrition support during pulmonary Tuberculosis treating course: Systematic review and meta-analysis. Chinese Med J. 2015;128.

Choi R, Kim H-T, Lim Y, et al. Serum concentrations of trace elements in patients with tuberculosis and its association with treatment outcome. Nutrients 2015;7:5969-81.

Leaf-nosed bat. Encyclopædia Britannica: Encyclopædia Britannica Online; 2009.

Senbeta A, Weldegerima G, Romha G. Survival analysis and associated risk factors of tuberculosis. In-hospital patiens’ death in Hawassa City and at Yirgalem Town Health Centers. World J Med Sci. 2014;11:382-8.

Gupta A, Ahmad FJ, Ahmad F, et al. Efficacy of Mycobacterium indicus pranii immunotherapy as an adjunct to chemotherapy for Tuberculosis and underlying immune responses in the lung. PLoS One. 2012;7.

Kenangalem E, Waramori G, Pontororing GJ, et al. Tuberculosis outcomes in Papua, Indonesia: The relationship with different body mass index characteristics between Papuan and Non-Papuan ethnic groups. PLoS One. 2013;8.

Leimane V, Riekstina V, Holtz TH, et al. Clinical outcome of individualised treatment of multidrug-resistant tuberculosis in Latvia: a retrospective cohort study. Lancet. 2005;365:318-26.

Atif M, Sulaiman SAS, Shafie AA, Ali I, Asif M, Babar Z-U-D. Treatment outcome of new smear positive pulmonary tuberculosis patients in Penang, Malaysia. BMC Infect Dis. 2014;14:1-8.

Mukhtar F, Butt ZA. Risk of adverse treatment outcomes among new pulmonary TB patients co-infected with diabetes in Pakistan: a prospective cohort study. Plos One. 2018;13:1-11.

Bei C, Fu M, Xie H, et al. Morality and associated factors of patients with extensive drug-resistant tuberculosis: an emerging public helath crisis in China. BMC Infect Dis. 2018;18:1-7.

Choi H, Lee M, Chen RY, et al. Predictor of pulmonary tuberculosis treatment outcomes in South Korea: a prospective cohort study, 2005-2012. BMC Infect Dis. 2014;14:1-12.

Gerbezgabiher G, Romha G, Ejeta E, Asebe G, Zemene E, Ameni G. Treatment outcomeof tuberculosis patients under directly observed treatment short course and factorsaffecting outcome in Southern Ethiopia: a five year retrospective study. PLOS One. 2016;11:1-10.

Full Text: PDF


  • There are currently no refbacks.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.