Determinants of multidrug-resistant tuberculosis in patients who underwent first-line treatment in Addis Ababa: a case control study.
Determinants of multidrug-resistant tuberculosis in patients who underwent first-line treatment in Addis Ababa: a case control study.
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DOI：
10.1186/1471-2458-13-782
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发表时间：
2013-08-28
影响因子：
4.5
通讯作者：
Ameni G
中科院分区：
文献类型：
--
作者：
Hirpa S;Medhin G;Girma B;Melese M;Mekonen A;Suarez P;Ameni G
2010年，全世界有65万例耐多药结核病病例，2008年世界卫生组织估计，每年有15万人死于耐多药结核病。埃塞俄比亚在27个耐多药结核病高负担国家中排名第15位。本研究确定了在亚的斯亚贝巴市接受一线结核病治疗的患者中发生耐多药结核病的相关因素。2011年11月1日至2012年2月30日在亚的斯亚贝巴圣彼得医院和五个保健中心进行了病例对照研究。病例为耐多药结核病患者，经培养和药敏试验证实，在研究期间在圣彼得医院接受治疗。对照者是2009年4月9日至2010年2月28日期间在亚的斯亚贝巴市五个保健中心登记治愈或完成治疗的一线抗结核治疗患者。因此，本研究纳入了134例病例和同等数量的对照组。采用结构化访谈问卷来评估可能与耐多药结核病发生相关的因素。与耐多药结核病显著相关的因素：一线治疗期间的药物副作用(调整优势比（AOR）： 4.5, 95% CI；1.9 - 10.5)；卫生工作者没有直接观察到治疗（AOR = 11.7, 95% CI; 4-34.3）；治疗中断至少1天（AOR = 13.1, 95% CI 3.0-56.6）；治疗时间2 ~ 7个月（AOR = 14.8, 95% CI 2.3 ~ 96.4）；II类方案再治疗（P = 0.000）。在目前的研究中，HIV感染与耐多药结核病的发生没有显著相关性。未接受严格督导下直接督导下的短程化疗计划且未坚持一线结核病治疗的患者，以及在一线治疗和第二类再治疗期间出现副作用的患者，发生耐多药结核病的风险显著增加。因此，应加强DOTS规划，以提高患者的依从性。在开始第二类治疗方案之前，强烈建议对所有第一类治疗方案失败的患者进行药敏试验。
Worldwide, there were 650,000 multidrug-resistant tuberculosis (MDR-TB) cases in 2010, and in 2008 the World Health Organization estimated that 150,000 deaths occurred annually due to MDR-TB. Ethiopia is 15th among the 27 MDR-TB high-burden countries. This study identifies factors associated with the occurrence of MDR-TB in patients who underwent first-line TB treatment in Addis Ababa City. A case control study was conducted at St. Peter Hospital and five health centers in Addis Ababa from 1 November 2011 to February 30, 2012. Cases were MDR-TB patients who were confirmed with culture and drug-susceptibility testing and were in treatment at St. Peter Hospital during the study period. Controls were patients who were on first-line anti-TB treatment and were registered as cured or having completed treatment in the period 9 April 2009– 28 February 2010, in five health centers of Addis Ababa City. Accordingly, 134 cases and an equal number of controls were included in this study. A structured interview questionnaire was used to assess factors that could potentially be associated with the occurrence of MDR-TB. Factors that were significantly associated with MDR-TB: drug side effects during first-line treatment (adjusted odds ratio (AOR): 4.5, 95% CI; 1.9 - 10.5); treatment not directly observed by a health worker (AOR = 11.7, 95% CI; 4–34.3); interruption of treatment of at least a day (AOR = 13.1, 95% CI 3.0-56.6); duration of treatment between 2 and 7 months (AOR = 14.8, 95% CI 2.3-96.4); and retreatment with the Category II regimen (P = 0.000). In the current study, HIV infection was not significantly associated with the occurrence of MDR-TB. Patients who were not in strict DOTS programs and did not adhere to first-line TB treatment and patients who experienced side effects during first-line treatment and Category II retreatment were at significantly increased risk of developing MDR-TB. The DOTS program should, therefore, be strengthened to increase patient adherence. Drug-susceptibility testing is also highly recommended for all Category I treatment regimen failures before those patients begin the Category II regimen.
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