Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town.
S Afr Med J. 2011 Jul 25;101(8):529-32.
OBJECTIVES. To define the patient population at Cape Town's district-level hospital offering specialist tuberculosis (TB) services, concerning the noted increase in complex, sick HIV-TB co-infected patients requiring increased levels of care. METHODS. A cross-sectional study of all hospitalised adult patients in Brooklyn Chest Hospital (a district-level hospital offering specialist TB services) from 27 - 30 October 2008. Outcome measures were: Type of TB and drug sensitivity, HIV co-infection, comorbidity, Karnofsky performance score, and frequency and reason for referral to other health care facilities. RESULTS. More than two-thirds of patients in the acute wards were HIV-co-infected, of whom 98% had significant comorbidities and 60% had a Karnofsky performance score ≤30. Twenty-eight per cent of patients did not have a confirmed diagnosis of TB. In contrast, long-stay patients with multi-drug-resistant (MDR), pre-extensively (pre-XDR) and extensively drug-resistant (XDR) TB had a lower prevalence of HIV co-infection, but manifested high rates of comorbidity. Overall, one-fifth of patients required up-referral to higher levels of care. CONCLUSIONS. District-level hospitals such as Brooklyn Chest Hospital that offer specialist TB services share the increasing burden of complex, sick, largely HIV-co-infected TB patients with their secondary and tertiary level counterparts. To support these hospitals effectively, outreach, skills transfer through training, and improved radiology resources are required to optimise patient care.
目的。确定开普敦区级医院提供专科结核病（TB）服务的患者人群，因为这里的复杂、重病的 HIV-TB 合并感染者数量增加，需要更高水平的护理。
方法。对 2008 年 10 月 27 日至 30 日在布鲁克林胸医院（提供专科结核病服务的区级医院）住院的所有成年患者进行横断面研究。结果测量指标为：TB 类型和药敏性、HIV 合并感染、合并症、卡诺夫斯基表现评分以及向其他医疗机构转诊的频率和原因。
结果。急性病房的三分之二以上患者为 HIV 合并感染，其中 98%有显著的合并症，60%的卡诺夫斯基表现评分≤30。28%的患者未确诊为结核病。相比之下，耐多药（MDR）、预广泛（pre-XDR）和广泛耐药（XDR）TB 的长期住院患者 HIV 合并感染率较低，但合并症发生率较高。总体而言，五分之一的患者需要向上转诊到更高水平的护理。
结论。像布鲁克林胸医院这样提供专科结核病服务的区级医院与二级和三级医疗机构一样，面临着复杂、重病、大量 HIV 合并感染的结核病患者的负担不断增加。为了有效支持这些医院，需要通过培训进行外展、技能转移，并改善放射学资源，以优化患者护理。
