Multidrug-resistant tuberculosis outbreak associated with poor treatment adherence and delayed treatment: Arua District, Uganda, 2013-2017
Multidrug-resistant tuberculosis outbreak associated with poor treatment adherence and delayed treatment: Arua District, Uganda, 2013-2017
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DOI：
10.1186/s12879-019-4014-3
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发表时间：
2019-05-07
影响因子：
3.7
通讯作者：
Zhu, Bao-Ping
中科院分区：
文献类型：
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作者：
Okethwangu, Denis;Birungi, Doreen;Zhu, Bao-Ping
2017年8月，乌干达卫生部获悉，2017年乌干达阿鲁阿地区耐多药结核病（MDR-TB）病例增加。我们进行了调查，以确定增加的范围和感染的风险因素，评估卫生设施管理耐多药结核病的能力，并建议循证控制措施。方法我们将耐多药结核病病例患者定义为2013-2017年期间在阿鲁阿地区转诊医院（ARRH）就诊的结核病患者，其痰液样本产生至少对利福平和异烟肼耐药的结核分枝杆菌，经批准的药物敏感性试验证实。我们回顾了ARRH的临床记录，并将2017年1月至8月期间的耐多药结核病例数与2013年至2016年同期进行了比较。为了确定耐多药结核病继发感染病例的特异性危险因素，我们进行了一项病例对照研究，使用与居住地分县匹配的药物敏感结核病患者作为对照。我们观察了卫生机构和社区的感染预防和控制措施，并评估卫生机构的能力，以管理TB。ResultsWe确定了33例耐多药结核病，其中30例继发性结核感染病例。2017年1月至8月的病例数为10例，而2013年至2016年1月至8月的病例数为3-4例（p=0.02）。男性比女性受影响更大（6.5 vs 1.6/100，000，p
BackgroundIn August 2017, the Uganda Ministry of Health was notified of increased cases of multidrug-resistant tuberculosis (MDR-TB) in Arua District, Uganda during 2017. We investigated to identify the scope of the increase and risk factors for infection, evaluate health facilities' capacity to manage MDR-TB, and recommend evidence-based control measures.MethodsWe defined an MDR-TB case-patient as a TB patient attending Arua Regional Referral Hospital (ARRH) during 2013-2017 with a sputum sample yielding Mycobacterium tuberculosis resistant to at least rifampicin and isoniazid, confirmed by an approved drug susceptibility test. We reviewed clinical records from ARRH and compared the number of MDR-TB cases during January-August 2017 with the same months in 2013-2016. To identify risk factors specific for MDR-TB among cases with secondary infection, we conducted a case-control study using persons with drug-susceptible TB matched by sub-county of residence as controls. We observed infection prevention and control practices in health facilities and community, and assessed health facilities' capacity to manage TB.ResultsWe identified 33 patients with MDR-TB, of whom 30 were secondary TB infection cases. The number of cases during January-August 2017 was 10, compared with 3-4 cases in January-August from 2013 to 2016 (p=0.02). Men were more affected than women (6.5 vs 1.6/100,000, p