Tuberculosis sanatorium treatment at the advent of the chemotherapy era.
Tuberculosis sanatorium treatment at the advent of the chemotherapy era.
复制标题
DOI：
10.1186/s12879-020-05539-w
复制
发表时间：
2020-11-11
影响因子：
3.7
通讯作者：
Pepperell CS
中科院分区：
文献类型：
--
作者：
Zwick ED;Pepperell CS
世纪中期抗生素的发现标志着结核病（TB）治疗和控制的重大转变。很少有研究描述结核病的持续时间和化疗前的治疗方法，也很少有数据说明这些治疗方法如何随着有效抗生素的发展而改变。本研究的目的是了解加拿大萨斯喀彻温省第一民族高发人群的住院治疗如何随着有效抗结核抗生素的可用性增加而改变。我们预计，随着治疗方案从仅恢复期过渡到三联抗生素治疗，住院治疗的时间将缩短。对1933年至1959年在加拿大萨斯喀彻温省发生的疗养院入院和出院记录进行了分析。抗生素发现的年份作为治疗方案的代表：无化疗（1944年以前）、单药治疗（链霉素，1944-1946年）、双联治疗（链霉素和PAS，1946-1952年）和三联治疗（链霉素、PAS和INH，1952年-）。对按入院年份预测的首次入院时间进行对数转换的合并线性回归建模，以评估入院时间和入院年份之间的关系，并对临床和人口统计学变量进行校正。与化疗前相比，三联疗法时代的首次住院时间增加了19%，从316天（10.4个月）增加到377天（12.4个月）。在INH（1952年）发现后，我们发现成功完成治疗的比例在统计学上显著增加（0.55 vs 0.60，p = 0.035），但也包括违背医嘱离开医院的患者（0.19对0.29，p < 0.0001），表明随着住院时间的延长，更多的患者选择在没有医生批准的情况下出院。再入院率从10%上升到50%，而省级结核病死亡率从1933年的63.1/10000下降到1958年的4.7/10000。与直觉相反，我们发现，随着结核病治疗抗生素的发现，首次入院的时间增加了。增加的入院量和再入院率表明，在这个时代加强了住院结核病治疗。这些分析提供了一个新的估计的影响，改变治疗政策，疗养院入院在这一人群。在线版本包含补充材料，可通过10.1186/s12879-020-05539-w获得。
The discovery of antibiotics in the mid-twentieth century marked a major transition in tuberculosis (TB) treatment and control. There are few studies describing the duration of TB disease and its treatment from the pre-chemotherapy era and little data on how these treatments changed in response to the development of effective antibiotics. The goal of this research is to understand how inpatient treatment for high incidence populations, the First Nations peoples of Saskatchewan, Canada, changed in response to increasing availability of antibiotics effective against TB. We expected that as treatment regimens transitioned from convalescence-only to triple antibiotic therapy, the length of inpatient treatment would shorten. Analyses were performed on records of sanatoria admissions and discharges occurring between 1933 and 1959 in Saskatchewan, Canada. Year of antibiotic discovery was taken as a proxy for treatment regimen: no chemotherapy (pre-1944), mono-therapy (Streptomycin, 1944–1946), dual-therapy (Streptomycin and PAS, 1946–1952), and triple-therapy (Streptomycin, PAS, and INH 1952-). A pooled linear regression of log-transformed length of first admission as predicted by year of admission was modeled to assess the relationship between admission length and year of admission, corrected for clinical and demographic variables. First admission length increased 19% in the triple-therapy era as compared to the pre-chemotherapy era, from 316 days (10.4 months) to 377 days (12.4 months). After the discovery of INH (1952), we find statistically significant increases in the proportion of successfully completed therapies (0.55 versus 0.60, p = 0.035), but also in patients who left hospital against medical advice (0.19 versus 0.29, p < 0.0001), indicating that as hospitalizations lengthened, more patients chose to discharge without the sanction of their physician. The readmission rate increased from 10 to 50% of all admissions while the province-level TB-specific death rate fell from 63.1 per 10,000 in 1933 to 4.7 per 10,000 in 1958. Counterintuitively, we find that the length of first admissions increased with the discovery of TB-treating antibiotics. Increasing admission volume and readmission rate indicate an intensification of inpatient TB treatment during this era. These analyses provide a novel estimate of the effect of changing treatment policy on sanatorium admissions in this population. The online version contains supplementary material available at 10.1186/s12879-020-05539-w.
登录
查看更多内容
结核病的自然病史：艾滋病毒阴性患者未经治疗的肺结核的持续时间和死亡：系统评价。
影响因子：
3.7
作者：
Tiemersma EW;van der Werf MJ;Borgdorff MW;Williams BG;Nagelkerke NJ
通讯作者：
Nagelkerke NJ
影响因子：
0.2
作者：
Lux, Maureen K.
通讯作者：
Lux, Maureen K.
影响因子：
10.7
作者：
Pepperell, Caitlin;Hoeppner, Vernon H.;Feldman, Marcus W.
通讯作者：
Feldman, Marcus W.
影响因子：
11.8
作者：
Nahid, Payam;Dorman, Susan E.;Vernon, Andrew
通讯作者：
Vernon, Andrew