Divisions of General Internal Medicine and Infectious Diseases, Department of Medicine, Montefiore Medical Center & Albert Einstein College of Medicine, Bronx, New York 10467, USA.
Int J Tuberc Lung Dis. 2010 Apr;14(4):413-9.
Multidrug-resistant tuberculosis (MDR-TB) has emerged as a significant public health threat in South Africa.
To describe treatment outcomes and determine risk factors associated with unfavorable outcomes among MDR-TB patients admitted to the provincial TB referral hospital in KwaZulu-Natal Province, South Africa.
Retrospective observational study of MDR-TB patients admitted from 2000 to 2003.
Of 1209 MDR-TB patients with documented treatment outcomes, 491 (41%) were cured, 35 (3%) completed treatment, 208 (17%) failed treatment, 223 (18%) died and 252 (21%) defaulted. Of the total number of patients with known human immunodeficiency virus (HIV) status, 52% were HIV-infected. Treatment failure, death and default each differed in their risk factors. Greater baseline resistance (aOR 2.3-3.0), prior TB (aOR 1.7), and diagnosis in 2001, 2002 or 2003 (aOR 1.9-2.3) were independent risk factors for treatment failure. HIV co-infection was a risk factor for death (aOR 5.6), and both HIV (aOR 2.0) and male sex (aOR 1.9) were risk factors for treatment default.
MDR-TB treatment outcomes in KwaZulu-Natal were substantially worse than those published from other MDR-TB cohorts. Interventions such as concurrent antiretroviral therapy and decentralized MDR-TB treatment should be considered to improve MDR-TB outcomes in this high HIV prevalence setting.
耐多药结核病（MDR-TB）已成为南非严重的公共卫生威胁。
描述南非夸祖鲁-纳塔尔省省级结核病转诊医院收治的耐多药结核病患者的治疗结局，并确定与不良结局相关的危险因素。
2000 年至 2003 年期间收治的耐多药结核病患者的回顾性观察研究。
在有记录治疗结局的 1209 例耐多药结核病患者中，491 例（41%）治愈，35 例（3%）完成治疗，208 例（17%）治疗失败，223 例（18%）死亡，252 例（21%）失访。在已知人类免疫缺陷病毒（HIV）状态的患者总数中，有 52%感染了 HIV。治疗失败、死亡和失访的风险因素各不相同。基线耐药程度更高（aOR 2.3-3.0）、既往结核病（aOR 1.7）以及 2001、2002 或 2003 年诊断（aOR 1.9-2.3）是治疗失败的独立危险因素。HIV 合并感染是死亡的危险因素（aOR 5.6），HIV（aOR 2.0）和男性（aOR 1.9）是治疗失访的危险因素。
夸祖鲁-纳塔尔省的耐多药结核病治疗结局明显差于其他耐多药结核病队列发表的结果。在这种 HIV 流行率高的环境中，应考虑同时进行抗逆转录病毒治疗和分散的耐多药结核病治疗等干预措施，以改善耐多药结核病的结局。
