Time to treatment and patient outcomes among TB suspects screened by a single point-of-care xpert MTB/RIF at a primary care clinic in Johannesburg, South Africa.
Time to treatment and patient outcomes among TB suspects screened by a single point-of-care xpert MTB/RIF at a primary care clinic in Johannesburg, South Africa.
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DOI：
10.1371/journal.pone.0065421
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发表时间：
2013
期刊：
影响因子：
3.7
通讯作者：
Van Rie A
中科院分区：
文献类型：
--
作者：
Hanrahan CF;Selibas K;Deery CB;Dansey H;Clouse K;Bassett J;Scott L;Stevens W;Sanne I;Van Rie A
2010年12月，世界卫生组织建议将单一Xpert MTB/RIF检测试剂盒作为疑似HIV相关或耐药结核病患者的初始诊断。关于这一建议对患者结局的影响，几乎没有数据。我们描述了使用单点护理Xpert筛查的结核病可疑者队列的诊断随访、临床特征和结局。在南非约翰内斯堡的一家初级保健诊所，使用床旁Xpert对疑似结核病患者进行了结核病评估。进行痰涂片显微镜检查和液体培养作为参考标准。Xpert阴性者进行临床评价，并由临床医生酌情进一步评估。参与者被跟踪了六个月。从2011年7月至9月，641名结核病嫌疑人被登记，其中69%是艾滋病毒感染者。8%的人被一个Xpert检测为阳性。在116例确诊为TB的患者中，66例（57%）为Xpert阴性，其中44例（67%）为经验或放射学诊断，22例（33%）为Xpert阴性/培养阳性。Xpert阳性患者至结核病治疗的中位时间为0天（IQR：0-0），经验诊断患者为14天（IQR：5-35），放射学诊断为14天（IQR：7-29），培养阳性患者为144天（IQR：28-180）。Xpert阴性结核病病例与Xpert阳性结核病病例在临床上相似，包括HIV状态和CD 4计数，治疗结局相似，包括死亡率和至开始抗逆转录病毒治疗的时间。在高艾滋病毒负担的环境中，一个Xpert发现了不到一半的开始结核病治疗的人，这凸显了即使在Xpert时代结核病诊断的复杂性。床旁Xpert导致Xpert阳性患者当天开始治疗，但对结核病治疗结局或死亡率没有影响。
In December 2010, the World Health Organization recommended a single Xpert MTB/RIF assay as the initial diagnostic in people suspected of HIV-associated or drug resistant tuberculosis. Few data are available on the impact of this recommendation on patient outcomes. We describe the diagnostic follow-up, clinical characteristics and outcomes of a cohort of tuberculosis suspects screened using a single point-of-care Xpert. Consecutive tuberculosis suspects at a primary care clinic in Johannesburg, South Africa were assessed for tuberculosis using point-of-care Xpert. Sputum smear microscopy and liquid culture were performed as reference standards. Xpert-negatives were evaluated clinically, and further assessed at the discretion of clinicians. Participants were followed for six months. From July-September 2011, 641 tuberculosis suspects were enrolled, of whom 69% were HIV-infected. Eight percent were positive by a single Xpert. Among 116 individuals diagnosed with TB, 66 (57%) were Xpert negative, of which 44 (67%) were empirical or radiological diagnoses and 22 (33%) were Xpert negative/culture-positive. The median time to tuberculosis treatment was 0 days (IQR: 0–0) for Xpert positives, 14 days (IQR: 5–35) for those diagnosed empirically, 14 days (IQR: 7–29) for radiological diagnoses, and 144 days (IQR: 28–180) for culture positives. Xpert negative tuberculosis cases were clinically similar to Xpert positives, including HIV status and CD4 count, and had similar treatment outcomes including mortality and time to antiretroviral treatment initiation. In a high HIV-burden setting, a single Xpert identified less than half of those started on tuberculosis treatment, highlighting the complexity of TB diagnosis even in the Xpert era. Xpert at point-of-care resulted in same day treatment initiation in Xpert-positives, but had no impact on tuberculosis treatment outcomes or mortality.
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10.1111/j.1365-3156.2012.03028.x
发表时间：
2012-09
期刊：
Tropical medicine & international health : TM & IH
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DOI：
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2010-09-09
期刊：
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影响因子：
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Boehme CC;Nabeta P;Hillemann D;Nicol MP;Shenai S;Krapp F;Allen J;Tahirli R;Blakemore R;Rustomjee R;Milovic A;Jones M;O'Brien SM;Persing DH;Ruesch-Gerdes S;Gotuzzo E;Rodrigues C;Alland D;Perkins MD
通讯作者：
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