Treatment outcomes of multidrug-resistant tuberculosis: a systematic review and meta-analysis.
Treatment outcomes of multidrug-resistant tuberculosis: a systematic review and meta-analysis.
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DOI：
10.1371/journal.pone.0006914
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发表时间：
2009-09-09
期刊：
影响因子：
3.7
通讯作者：
Fitzgerald JM
中科院分区：
文献类型：
--
作者：
Johnston JC;Shahidi NC;Sadatsafavi M;Fitzgerald JM
与药物敏感性疾病相比，耐多药结核分枝杆菌（MDRTB）的治疗结果通常较差。我们试图估计治疗结果，并确定与耐多药结核患者的不良结局相关的风险因素。我们进行了一项系统性检索（至2008年12月），以确定描述MDRTB治疗患者结局的试验。我们汇总了适当的数据，以估计治疗结束和随访时WHO定义的结局。在适当的情况下，对合并的协变量进行分析，以确定与不良结局相关的因素。在识别的文章中，36篇符合我们的纳入标准，代表了来自21个国家的31个治疗方案。在一项汇总分析中，62% [95% CI 57-67]的患者结局成功，13%的患者违约，11%的患者死亡，2%的患者转出。与不良结局相关的因素包括男性0.61（成功结局的OR）[0.46-0.82]，酗酒0.49 [0.39-0.63]，低BMI 0.41[0.23-0.72]，诊断时涂片阳性0.53 [0.31-0.91]，氟喹诺酮类耐药0.45 [0.22-0.91]和XDR耐药模式的存在0.57 [0.41-0.80]。与成功结局相关的因素为手术干预1.91 [1.44-2.53]，既往未治疗1.42 [1.05-1.94]，氟喹诺酮类药物使用2.20 [1.19-4.09]。我们已经确定了几个与不良结局相关的因素，这些因素可能是干预措施的目标。此外，我们发现了高违约率，这可能有助于MDRTB的发展和传播。
Treatment outcomes for multidrug-resistant Mycobacterium Tuberculosis (MDRTB) are generally poor compared to drug sensitive disease. We sought to estimate treatment outcomes and identify risk factors associated with poor outcomes in patients with MDRTB. We performed a systematic search (to December 2008) to identify trials describing outcomes of patients treated for MDRTB. We pooled appropriate data to estimate WHO-defined outcomes at the end of treatment and follow-up. Where appropriate, pooled covariates were analyzed to identify factors associated with worse outcomes. Among articles identified, 36 met our inclusion criteria, representing 31 treatment programmes from 21 countries. In a pooled analysis, 62% [95% CI 57–67] of patients had successful outcomes, while 13% defaulted, 11% died, and 2% were transferred out. Factors associated with worse outcome included male gender 0.61 (OR for successful outcome) [0.46–0.82], alcohol abuse 0.49 [0.39–0.63], low BMI 0.41[0.23–0.72], smear positivity at diagnosis 0.53 [0.31–0.91], fluoroquinolone resistance 0.45 [0.22–0.91] and the presence of an XDR resistance pattern 0.57 [0.41–0.80]. Factors associated with successful outcome were surgical intervention 1.91 [1.44–2.53], no previous treatment 1.42 [1.05–1.94], and fluoroquinolone use 2.20 [1.19–4.09]. We have identified several factors associated with poor outcomes where interventions may be targeted. In addition, we have identified high rates of default, which likely contributes to the development and spread of MDRTB.
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影响因子：
11.8
作者：
Kim, Hye-Ryoun;Hwang, Seung Sik;Yim, Jae-Joon
通讯作者：
Yim, Jae-Joon
影响因子：
168.9
作者：
Keshavjee, Salmaan;Gelmanova, Irina Y.;Shin, Sonya S.
通讯作者：
Shin, Sonya S.
DOI：
10.1016/0962-8479(95)90529-4
发表时间：
1995-12-01
期刊：
TUBERCLE AND LUNG DISEASE
影响因子：
--
作者：
Kim, SJ;Hong, YP;Lee, EG
通讯作者：
Lee, EG
影响因子：
11.8
作者：
Burgos, M;Gonzalez, LC;Daley, CL
通讯作者：
Daley, CL
DOI：
10.1164/rccm.200801-132oc
发表时间：
2008-11-15
影响因子：
24.7
作者：
Kim, Doh Hyung;Kim, Hee Jin;Shim, Tae Sun
通讯作者：
Shim, Tae Sun