Clinical characteristics and treatment outcomes of patients with MDR tuberculosis in Dar Es Salaam region, Tanzania.
Clinical characteristics and treatment outcomes of patients with MDR tuberculosis in Dar Es Salaam region, Tanzania.
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DOI：
10.1093/jacamr/dlaa108
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发表时间：
2020-12
影响因子：
3.4
通讯作者：
Matee MIN
中科院分区：
文献类型：
--
作者：
Myemba DT;Bwire GM;Sambayi G;Maganda BA;Njiro BJ;Ndumwa HP;Majani F;Kunambi PP;Matee MIN
在坦桑尼亚，28%以上的耐多药结核病病例发生在达累斯萨拉姆。然而，有关该地区耐多药结核病患者的管理和临床结局的信息很少，因此需要进行这项研究。在达累斯萨拉姆的六个中心进行了一项为期5年的回顾性队列研究。使用描述性统计量总结社会人口统计学和临床特征。使用卡方检验确定不良事件发生、方案改变和治愈之间的关联，而使用对数秩和检验和考克斯回归模型确定与死亡率相关的因素。找到并审查了300份患者档案。大多数为男性，199人（66.3%），年龄在25-44岁之间[176人（58.7%）]，89人（30.1%）为艾滋病毒合并感染者。186例（62%）完成治疗，68例（22.0%）正在接受治疗，9例（3.3%）失访。大多数，152例（51.0%）使用长期耐多药结核治疗方案进行管理。总体死亡率为每1 000名耐多药结核病患者中5.7人。年龄≥45岁的患者死亡率较高[校正风险比（AHR）：10.82，95% CI：1.14-102.74，P = 0.038），女性（AHR：5.92，95% CI：1.75-20.08，P = 0.004），接受短期抗结核治疗方案（AHR：4.34，95% CI：1.41-13.35，P = 0.010），HIV合并感染[粗风险比（AUC）：2.56，95% CI：1.01-6.50，P = 0.048），长期伴随用药（风险系数：2.99，95% CI：1.17-7.64，P = 0.022）和有其他合并症（χ 2 = 3.45，95%CI：1.32-9.02，P = 0.011）。 耐多药结核病死亡率与短期抗结核治疗方案、性别、年龄、伴随长期用药和艾滋病毒合并感染有关。在这一人群中，建议使用长期和个性化的治疗方案。
In Tanzania more than 28% of all multi-drug resistant tuberculosis (MDR-TB) cases occur in Dar es Salaam. However, information about management and clinical outcomes of patients with MDR-TB in the region is scarce, and hence the need for this study. A 5-year retrospective cohort study was conducted in six centres in Dar es Salaam. Descriptive statistics were used to summarize social demographics and clinical characteristics. Associations between occurrence of adverse events, regimen change and cure were determined using the Chi-square test whereas factors associated with mortality were determined using the Log-ranking test and Cox regression model. Three-hundred patient files were found and reviewed. The majority were male 199 (66.3%), aged 25–44 years [176 (58.7%)] and 89 (30.1%) were HIV co-infected. 186 (62%) completed their treatment, 68 (22.0%) were on treatment and 9 (3.3%) were lost to follow-up. The majority, 152 (51.0%) were managed using long MDR-TB regimens. The overall mortality rate was 5.7 per 1000 MDR-TB patients. A higher mortality rate was associated with being ≥45 years [adjusted hazard ratio (AHR): 10.82, 95% CI: 1.14–102.74, P = 0.038), female (AHR: 5.92, 95% CI: 1.75–20.08, P = 0.004), on a short anti-TB regimen (AHR: 4.34, 95% CI: 1.41–13.35, P = 0.010), HIV co-infected [crude hazard ratio (CHR): 2.56, 95% CI: 1.01–6.50, P = 0.048), on concomitant long-term medication use (CHR: 2.99, 95% CI: 1.17–7.64, P = 0.022) and having other co-morbidities (CHR: 3.45, 95% CI: 1.32–9.02, P = 0.011). MDR-TB mortality was associated with short anti-TB regimens, sex, age, concomitant long-term medication use and HIV coinfection. In this population, use of long and individualized regimens is recommended.