Wobeser W, Yuan L, Naus M
Department of Medicine, Queen's University, Kingston, Ont.
CMAJ. 1999 Mar 23;160(6):789-94.
Completion of treatment of active cases of tuberculosis (TB) is the most important priority of TB control programs. This study was carried out to assess treatment completion for active cases of pulmonary TB in Toronto.
Consecutive cases of culture-proven pulmonary TB were obtained from the microbiology laboratories of 5 university-affiliated tertiary care centres in Toronto in 1992/93. A standard data-collection tool was used to abstract information from inpatient and outpatient charts. For patients who were transferred to other treatment centres or lost to follow-up, the local health unit was contacted for information about treatment completion. If incomplete information was obtained from these sources, data from the provincial Reportable Disease Information System were also reviewed. The main outcome analysed was treatment outcome, with cases classified as completed (record of treatment completion noted), transferred (patient transferred to another centre but no treatment results available), defaulted (record of defaulting in patient chart but no record of treatment completion elsewhere, or patient still receiving treatment more than 15 months after diagnosis) or dead (patient died before treatment completion).
Of the 145 patients 84 (58%) completed treatment, 25 (17%) died, 22 (15%) defaulted and 14 (10%) were transferred. The corresponding values for the 22 patients with HIV coinfection were 6 (27%), 5 (23%), 8 (36%) and 3 (14%). Independent predictors of failure to complete treatment were injection drug use (adjusted odds ratio [OR] 5.7, 95% confidence interval [CI] 1.5 to 22.0), HIV infection (adjusted OR 4.6, 95% CI 1.4 to 14.7) and adverse drug reaction (adjusted OR 2.9, 95% CI 1.1 to 7.9). Independent predictors of death included age more than 50 years (adjusted OR 16.7, 95% CI 2.6 to 105.1), HIV infection (adjusted OR 16.1, 95% CI 3.9 to 66.4), immunosuppressive therapy (adjusted OR 8.0, 95% CI 1.9 to 34.4) and infection with a multidrug-resistant organism (adjusted OR 30.7, 95% CI 1.5 to 623.0).
Treatment completion rates in tertiary care hospitals in Toronto in 1992/93 were below the rate recommended by the World Health Organization. Careful surveillance of treatment completion is necessary for the management of TB in metropolitan centres in Canada.
完成活动性肺结核病例的治疗是结核病控制规划的首要重点。本研究旨在评估多伦多市活动性肺结核病例的治疗完成情况。
1992/1993年，从多伦多市5家大学附属三级护理中心的微生物实验室获取经培养证实的连续性肺结核病例。使用标准数据收集工具从住院和门诊病历中提取信息。对于转至其他治疗中心或失访的患者，与当地卫生部门联系以获取治疗完成情况的信息。如果从这些来源获得的信息不完整，还会查阅省级法定疾病信息系统的数据。分析的主要结局是治疗结果，病例分为已完成（有治疗完成记录）、已转移（患者转至另一中心但无治疗结果）、违约（患者病历中有违约记录但其他地方无治疗完成记录，或患者在诊断后15个月以上仍在接受治疗）或死亡（患者在治疗完成前死亡）。
145例患者中，84例（58%）完成治疗，25例（17%）死亡，22例（15%）违约，14例（10%）已转移。22例合并感染HIV的患者的相应数值分别为6例（27%）、5例（23%）、8例（36%）和3例（14%）。未完成治疗的独立预测因素包括注射吸毒（调整后的优势比[OR]为5.7，95%置信区间[CI]为1.5至22.0）、HIV感染（调整后的OR为4.6，95%CI为1.4至14.7）和药物不良反应（调整后的OR为2.9，95%CI为1.1至7.9）。死亡的独立预测因素包括年龄超过50岁（调整后的OR为16.7，95%CI为2.6至105.1）、HIV感染（调整后的OR为第16.1，95%CI为3.9至66.4）、免疫抑制治疗（调整后的OR为8.0，95%CI为1.9至34.4）和耐多药菌感染（调整后的OR为30.7，95%CI为1.5至623.0）。
1992/1993年多伦多市三级护理医院的治疗完成率低于世界卫生组织推荐的水平。对加拿大各主要城市中心的结核病管理而言，仔细监测治疗完成情况很有必要。
