Predictors of poor treatment outcome in multi- and extensively drug-resistant pulmonary TB
Predictors of poor treatment outcome in multi- and extensively drug-resistant pulmonary TB
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DOI：
10.1183/09031936.00155708
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发表时间：
2009-05-01
影响因子：
24.3
通讯作者：
Altraja, A.
中科院分区：
文献类型：
--
作者：
Kliiman, K.;Altraja, A.
耐多药（MDR）和广泛耐药（XDR）结核病（TB）的治疗结果往往不成功，但治疗结果不佳的具体决定因素仍然不清楚。因此，作者分析了爱沙尼亚肺耐多药结核病和广泛耐药结核病治疗效果不佳的预测因素，爱沙尼亚是世界上耐多药结核病和广泛耐药结核病发病率最高的欧洲国家之一。纳入了所有在 2003 年至 2005 年开始结核病治疗并经培养确诊的耐多药结核病和广泛耐药结核病患者。对两个预测模型进行了多变量分析：1）患者的艾滋病毒状况、人口和社会经济特征； 2）结核病相关数据。在235名耐多药结核病患者中，总体治疗成功率为60.4%，依从患者中上升至72.8%。在 54 名广泛耐药结核病患者中，这一比例分别为 42.6% 和 50.0%。耐多药结核病治疗效果不佳的危险因素包括 HIV 感染、既往结核病治疗、对氧氟沙星耐药以及治疗开始时抗酸杆菌 (AFB) 涂片阳性。 XDR-TB 治疗结果不佳的预测因素是城市居住和 AFB 涂片阳性。这项全国性研究提供的证据表明，为了改善耐多药和广泛耐药结核病的治疗结果，应特别注意治疗 HIV 感染者和城市居民，并努力通过提高患者依从性来减少重复治疗病例。
Treatment outcome in multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) is often unsuccessful, but the particular determinants of poor treatment outcome have remained obscure. The present authors therefore analysed treatment effectiveness and predictors of poor treatment outcome in pulmonary MDR-TB and XDR-TB in Estonia, a European country with one of the highest MDR-TB and XDR-TB rates in the world.All culture-confirmed pulmonary MDR-TB and XDR-TB patients who started TB treatment in 2003-2005 were included. Multivariate analysis was performed on two models of predictors: 1) patients' HIV-status, demographic and socioeconomic characteristics; and 2) TB-related data.In the 235 MDR-TB patients, the proportion of overall successful treatment outcome was 60.4%, rising to 72.8% among adherent patients. Among the 54 XDR-TB patients, these proportions were 42.6% and 50.0%, respectively. Risk factors for poor treatment outcome in MDR-TB were HIV infection, previous TB treatment, resistance to ofloxacin and positive acid-fast bacilli (AFB) smear at the start of treatment. Predictors of poor treatment outcome in XDR-TB were urban residence and positive AFB smear.This country-wide study provides evidence that to improve treatment outcome in multidrug-resistant and extensively drug-resistant tuberculosis, special care should be taken to treat HIV-infected patients and urban residents, as well as to make efforts to diminish re-treatment cases by increasing patient adherence.