Munsiff S S, Ahuja S D, Li J, Driver C R
New York City Department of Health and Mental Hygiene, NY 10007, USA.
Int J Tuberc Lung Dis. 2006 Jun;10(6):639-48.
An urban tuberculosis control program where an enhanced multidrug-resistant tuberculosis (MDR-TB) management plan coordinated care with multiple providers.
To evaluate treatment outcomes of primary MDR-TB patients treated by multiple providers.
Retrospective cohort study of tuberculosis patients from 1992-1997 provided that 1) their Mycobacterium tuberculosis isolates were resistant to at least isoniazid and rifampin, and 2) they had had < or = 30 days of anti-tuberculosis treatment prior to the collection of the first MDR-TB specimen.
More than 100 facilities and providers reported 856 MDR-TB patients. Treatment completion reached 70% among non-HIV-infected and 30% among HIV-infected persons; 57.2% of the cohort died prior to treatment completion, 26.5% completed treatment, 16.0% transferred out, refused treatment or were lost to follow-up and 0.2% are still in care. Diagnosis in the later years of the study or cavitation on chest radiograph was independently associated with increased completion among HIV-infected patients. Eight of the 227 (3.5%) patients who completed treatment relapsed (relapse rate 1.01/100 person-years), two with drug-susceptible strains.
A comprehensive MDR-TB control program improved the outcomes of both HIV-infected and non-infected individuals, despite management by multiple providers. Relapse was infrequent among patients who completed the recommended regimens.
在一个城市结核病控制项目中，一项强化的耐多药结核病（MDR-TB）管理计划协调了多个医疗机构的护理工作。
评估由多个医疗机构治疗的原发性耐多药结核病患者的治疗效果。
对1992年至1997年的结核病患者进行回顾性队列研究，条件为：1）其结核分枝杆菌分离株至少对异烟肼和利福平耐药；2）在采集首个耐多药结核病标本之前，他们接受抗结核治疗的时间≤30天。
100多个机构和医疗人员报告了856例耐多药结核病患者。未感染艾滋病毒者的治疗完成率达到70%，感染艾滋病毒者为30%；57.2%的队列患者在治疗完成前死亡，26.5%完成治疗，16.0%转出、拒绝治疗或失访，0.2%仍在接受治疗。在研究后期确诊或胸部X线片有空洞与感染艾滋病毒患者治疗完成率增加独立相关。227例完成治疗的患者中有8例（3.5%）复发（复发率为1.01/100人年），2例为药物敏感菌株。
尽管由多个医疗机构管理，但一项全面的耐多药结核病控制项目改善了感染艾滋病毒和未感染艾滋病毒个体的治疗效果。完成推荐治疗方案的患者复发很少见。
