The International Union Against Tuberculosis and Lung Disease, Paris, France.
PLoS One. 2011;6(12):e28034. doi: 10.1371/journal.pone.0028034. Epub 2011 Dec 14.
Although the World Health Organization (WHO) provides information on the number of TB patients categorised as "other", there is limited information on treatment regimens or treatment outcomes for "other". Such information is important, as inappropriate treatment can lead to patients remaining infectious and becoming a potential source of drug resistance. Therefore, using a cohort of TB patients from a large registration centre in Lilongwe, Malawi, our study determined the proportion of all TB re-treatment patients who were registered as "other", and described their characteristics and treatment outcomes.
This retrospective observational study used routine program data to determine the proportion of all TB re-treatment patients who were registered as "other" and describe their characteristics and treatment outcomes between January 2006 and December 2008.
1,384 (12%) of 11,663 TB cases were registered as re-treatment cases. Of these, 898 (65%) were categorised as "other": 707 (79%) had sputum smear-negative pulmonary TB and 191 (21%) had extra pulmonary TB. Compared to the smear-positive relapse, re-treatment after default (RAD) and failure cases, smear-negative "other" cases were older than 34 years and less likely to have their HIV status ascertained. Among those with known HIV status, "other" TB cases were more likely to be HIV positive. Of TB patients categorised as "other", 462 (51%) were managed on the first-line regimen with a treatment success rate of 63%.
A large proportion of re-treatment patients were categorised as "other". Many of these patients were HIV-infected and over half were treated with a first-line regimen, contrary to national guidelines. Treatment success was low. More attention to recording, diagnosis and management of these patients is warranted as incorrect treatment regimen and poor outcomes could lead to the development of drug resistant forms of TB.
世界卫生组织（WHO）提供了分类为“其他”的结核病人数量信息，但关于“其他”的治疗方案或治疗结果的信息有限。此类信息很重要，因为不适当的治疗可能导致患者仍然具有传染性，并成为耐药性的潜在来源。因此，我们利用马拉维利隆圭的一个大型注册中心的结核病人队列，确定了所有复治结核病人中被登记为“其他”的比例，并描述了他们的特征和治疗结果。
这项回顾性观察性研究使用常规项目数据，确定了所有复治结核病人中被登记为“其他”的比例，并描述了他们的特征和 2006 年 1 月至 2008 年 12 月期间的治疗结果。
在 11663 例结核病例中，有 1384 例（12%）被登记为复治病例。其中 898 例（65%）被分类为“其他”：707 例（79%）为痰涂片阴性肺结核，191 例（21%）为肺外结核。与痰涂片阳性复发、治疗失败和治疗后失败病例相比，痰涂片阴性“其他”病例的年龄大于 34 岁，并且其 HIV 状态确定的可能性较小。在已知 HIV 状态的病例中，“其他”结核病例更可能 HIV 阳性。在分类为“其他”的结核病人中，有 462 例（51%）接受了一线方案治疗，治疗成功率为 63%。
很大一部分复治病人被分类为“其他”。这些病人中有许多是 HIV 感染者，超过一半的人接受了一线方案治疗，这与国家指南相悖。治疗成功率较低。需要更加关注这些病人的记录、诊断和管理，因为不正确的治疗方案和较差的治疗结果可能导致耐药形式的结核发展。
