Risk factors and mortality associated with default from multidrug-resistant tuberculosis treatment
Risk factors and mortality associated with default from multidrug-resistant tuberculosis treatment
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DOI：
10.1086/588292
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发表时间：
2008-06-15
影响因子：
11.8
通讯作者：
Mitnick, Carole D.
中科院分区：
文献类型：
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作者：
Franke, Molly F.;Appleton, Sasha C.;Mitnick, Carole D.
背景完成耐多药（MDR）结核病（TB）的治疗可能比完成一线结核病治疗更具挑战性，特别是在资源匮乏的环境中。本研究的目的是（1）确定MDR TB治疗（定义为长期治疗中断）失败的风险因素，（2）量化治疗失败患者的死亡率，（3）确定治疗失败后死亡的风险因素。我们进行了一项回顾性病历回顾以确定耐多药结核病治疗失败的风险因素，并进行了家访以评估这些治疗失败患者的死亡率。671例患者中有67例（10.0%）未接受MDR TB治疗。至治疗默认的中位时间为438天（四分位距，152-710天），67例治疗默认的患者中有27例（40.3%）在默认时痰培养阳性。物质使用（风险比，2.96; 95%置信区间，1.56-5.62;），住房条件不达标（风险比，1.83; 95%置信区间，1.07-3.11; P=.03），入组后一年（危险比，1.62，95%可信区间，1.09-2.41; P=.02），健康区（P=.02）在多变量分析中预测治疗的默认值。严重的不良事件并不能预测治疗的失败。成功追踪了67例治疗违约患者中的47例（70.1%）;其中25例（53.2%）死亡。细菌学反应差，
Background. Completing treatment for multidrug-resistant (MDR) tuberculosis (TB) may be more challenging than completing first-line TB therapy, especially in resource-poor settings. The objectives of this study were to (1) identify risk factors for default from MDR TB therapy (defined as prolonged treatment interruption), (2) quantify mortality among patients who default from treatment, and (3) identify risk factors for death after default from treatment.Methods. We performed a retrospective chart review to identify risk factors for default from MDR TB therapy and conducted home visits to assess mortality among patients who defaulted from such therapy.Results. Sixty-seven (10.0%) of 671 patients defaulted from MDR TB therapy. The median time to treatment default was 438 days (interquartile range, 152-710 days), and 27 (40.3%) of the 67 patients who defaulted from treatment had culture-positive sputum at the time of default. Substance use (hazard ratio, 2.96; 95% confidence interval, 1.56-5.62;), substandard housing conditions (hazard ratio, 1.83; 95% confidence interval, 1.07-3.11; P=.03), later year of enrollment (hazard ratio, 1.62, 95% confidence interval, 1.09-2.41; P=.02), and health district (P=.02) predicted default from therapy in a multivariable analysis. Severe adverse events did not predict default from therapy. Forty-seven (70.1%) of 67 patients who defaulted from therapy were successfully traced; of these, 25 (53.2%) had died. Poor bacteriologic response,