Singla R, Srinath D, Gupta S, Visalakshi P, Khalid U K, Singla N, Gupta U A, Bharty S K, Behera D
Department of Tuberculosis and Chest Diseases, Lala Ram Sarup Institute of Tuberculosis and Respiratory Diseases, New Delhi, India.
Int J Tuberc Lung Dis. 2009 Apr;13(4):521-6.
Tertiary level tuberculosis (TB) institute in Delhi, India.
To study the risk factors for new pulmonary TB (PTB) patients failing treatment.
Prospective case-control study. The profile of new PTB patients failing treatment (i.e., sputum smear-positive at 5 months of treatment) and responders under the Revised National Tuberculosis Control Programme (RNTCP) were compared and risk factors associated with treatment failure were analysed.
A total of 42 treatment failure cases and 76 controls were enrolled in the study. The presence of cavity on chest X-ray (CXR), sputum acid-fast bacilli (AFB) smear positivity at 2 months of treatment and the number of interruptions in treatment were independently associated with failures. Among failure patients at 5 months, 17 (40.5%) had negative sputum culture for Mycobacterium tuberculosis, and only six (14.3%) had multidrug-resistant TB (MDR-TB). When put on retreatment, patients with smear-positive, culture-negative sputum had cure rates of 88.2% compared to 28.6% among culture-positive patients.
The presence of cavity on CXR, sputum smear positivity at 2 months of treatment and the number of interruptions of treatment are risk factors for failure. Among failures based on smear examination, the prevalence of MDR-TB is low and many patients have negative cultures for M. tuberculosis. Smear positivity at the end of treatment may not be a reliable indicator of treatment failure.
印度新德里的三级结核病研究所。
研究初治肺结核（PTB）患者治疗失败的危险因素。
前瞻性病例对照研究。比较了在修订的国家结核病控制规划（RNTCP）下治疗失败的初治PTB患者（即治疗5个月时痰涂片阳性）和治疗有效的患者，并分析了与治疗失败相关的危险因素。
共纳入42例治疗失败病例和76例对照。胸部X线片（CXR）显示有空洞、治疗2个月时痰抗酸杆菌（AFB）涂片阳性以及治疗中断次数与治疗失败独立相关。在5个月时治疗失败的患者中，17例（40.5%）结核分枝杆菌痰培养阴性，仅6例（14.3%）为耐多药结核病（MDR-TB）。再次治疗时，涂片阳性、培养阴性的患者治愈率为88.2%，而培养阳性患者的治愈率为28.6%。
CXR显示有空洞、治疗2个月时痰涂片阳性以及治疗中断次数是治疗失败的危险因素。在基于涂片检查的治疗失败患者中，MDR-TB的患病率较低，许多患者结核分枝杆菌培养阴性。治疗结束时涂片阳性可能不是治疗失败的可靠指标。
