Early Empirical Tuberculosis Treatment in HIV-Positive Patients Admitted to Hospital in South Africa: An Observational Cohort Study.
Early Empirical Tuberculosis Treatment in HIV-Positive Patients Admitted to Hospital in South Africa: An Observational Cohort Study.
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在南非住院的hiv阳性患者的早期结核病经验治疗：一项观察性队列研究。
DOI：
10.1093/ofid/ofab162
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发表时间：
2021-07
影响因子：
4.2
通讯作者：
Gupta-Wright A
中科院分区：
文献类型：
--
作者：
Bresges C;Wilson D;Fielding K;Corbett EL;Del-Greco F;Grint D;Peters J;Gupta-Wright A
人类免疫缺陷病毒（HIV）阳性住院患者的经验性结核病（TB）治疗很常见，可能会破坏新诊断的影响。我们试图描述经验性结核病治疗，并比较筛选后接受结核病治疗的患者的特征和结局。这是一项回顾性观察性队列研究，研究对象是在结核病筛查前接受经验性结核病治疗的HIV阳性住院患者。从病历中收集临床特征、检查和结局的数据。使用Xpert MTB/RIF和尿液脂阿拉伯甘露聚糖检测进行结核病筛查后，采用微生物学确诊或经验性结核病治疗的比较队列取自南非结核病筛查以降低非洲住院患者艾滋病相关死亡率（STAMP）试验中心。采用校正了年龄、性别和CD4细胞计数的竞争风险分析比较住院死亡率。在2016年1月至2017年9月期间，100名被排除在STAMP之外的患者在结核病筛查之前接受了经验性结核病治疗。在登记STAMP和TB筛查后，1177例患者中有240例（20.4%）接受了TB治疗，其中123例TB检测阳性，117例经验性治疗。早期经验治疗的患者和结核病筛查后治疗的患者的特征相似。50%的早期经验性结核病治疗基于放射学检查，22%基于脑脊液或胸腔液检测，28%仅基于临床特征。100例经验性治疗的患者中只有11例随后进行了微生物确认。经微生物学证实的结核病患者的住院死亡率低于经验治疗的患者（调整后的子分布风险比，0.5 [95%置信区间，.3-.9]）。经验性结核病治疗在重症艾滋病毒阳性住院患者中仍然很常见。这些患者可能受益于使用现有快速诊断法进行的结核病筛查，这既可以提高结核病的确诊率，又可以减少对结核病的过度治疗。HIV阳性住院患者的早期经验性结核病（TB）治疗很常见，患者具有相似的特征，但死亡率高于微生物确认的TB。这一群体可能受益于快速结核病诊断、提高结核病确诊率和减少过度治疗。
Empirical tuberculosis (TB) treatment in human immunodeficiency virus (HIV)–positive inpatients is common and may undermine the impact of new diagnostics. We sought to describe empirical TB treatment and compare characteristics and outcomes with patients treated for TB after screening. This was a retrospective observational cohort study of HIV-positive inpatients treated empirically for TB prior to TB screening. Data on clinical characteristics, investigations, and outcomes were collected from medical records. Comparison cohorts with microbiologically confirmed or empirical TB treatment after TB screening with Xpert MTB/RIF and urine lipoarabinomannan assays were taken from South African Screening for Tuberculosis to Reduce AIDS-Related Mortality in Hospitalized Patients in Africa (STAMP) trial site. In-hospital mortality was compared using a competing-risks analysis adjusted for age, sex, and CD4 cell count. Between January 2016 and September 2017, 100 patients excluded from STAMP were treated for TB empirically prior to TB screening. After enrollment in STAMP and TB screening, 240 of 1177 (20.4%) patients received TB treatment, of whom 123 had positive TB tests and 117 were treated empirically. Characteristics were similar among early empirically treated patients and those treated after TB screening. 50% of early empirical TB treatment was based on radiological investigations, 22% on cerebrospinal or pleural fluid testing, and 28% on clinical features alone. Only 11 of 100 empirically treated patients had subsequent microbiological confirmation. In-hospital mortality was lower in patients with microbiologically confirmed TB compared to those treated empirically (adjusted subdistribution hazard ratio, 0.5 [95% confidence interval, .3–.9). Empirical TB treatment remains common in severely ill HIV-positive inpatients. These patients may benefit from TB screening using existing rapid diagnostics, both to improve confirmation of TB disease and reduce overtreatment for TB. Early empirical tuberculosis (TB) treatment in HIV-positive inpatients is common, with patients having similar characteristics but higher mortality than those with microbiological confirmation of TB. This group may benefit from rapid TB diagnostics improve confirmation of TB disease and reduce over-treatment.
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DOI：
10.1016/s0140-6736(18)31267-4
发表时间：
2018-07-28
期刊：
Lancet (London, England)
影响因子：
--
作者：
Gupta-Wright A;Corbett EL;van Oosterhout JJ;Wilson D;Grint D;Alufandika-Moyo M;Peters JA;Chiume L;Flach C;Lawn SD;Fielding K
通讯作者：
Fielding K
影响因子：
56.3
作者：
Holtz, Timothy H.;Kabera, Gaetan;Rustomjee, Roxana
通讯作者：
Rustomjee, Roxana
影响因子：
16.1
作者：
Grant, Alison D.;Charalambous, Salome;Fielding, Katherine L.
通讯作者：
Fielding, Katherine L.
影响因子：
158.5
作者：
Blanc, Francois-Xavier;Badje, Anani D.;Laureillard, Didier
通讯作者：
Laureillard, Didier
影响因子：
4.1
作者：
Lawn, Stephen D.;Harries, Anthony D.;Wood, Robin
通讯作者：
Wood, Robin