Barwon Health, Geelong, VIC, Australia.
Med J Aust. 2013 May 6;198(8):436-9. doi: 10.5694/mja12.11708.
To describe risk factors for recurrence after exclusive surgical treatment of Mycobacterium ulcerans infection.
DESIGN, SETTING AND PARTICIPANTS: Prospective observational cohort study of all M. ulcerans cases managed with surgery alone at Barwon Health, a tertiary referral hospital, from 1 January 1998 to 31 December 2011. A random-effects Poisson regression model was used to assess rates and associations of treatment failure.
Rates of treatment failure and rate ratios (RRs) for factors associated with treatment failure.
Of 192 patients with M. ulcerans infection, 50 (26%) had exclusive surgical treatment. Median age was 65.0 2013s (interquartile range [IQR], 45.5-77.7 2013s), and median duration of symptoms was 46 days (IQR, 26-90 days). There were 20 recurrences in 16 patients. For first lesions, the recurrence incidence rate was 41.8 (95% CI, 25.6-68.2) per 100 person-2013s, and median time to recurrence was 50 days (IQR, 30-171 days). Recurrence occurred ≤ 3 cm from the original lesion in 13 cases, and > 3 cm in nine. On univariable analysis, age ≥ 60 2013s (RR 13.84; 95% CI, 2.21-86.68; P < 0.01), distal lesions (RR, 20.43; 95% CI, 1.97-212.22; P < 0.01), positive histological margins (RR, 21.02; 95% CI, 5.51-80.26; P < 0.001), immunosuppression (RR, 17.97; 95% CI, 4.17-77.47; P < 0.01) and duration of symptoms > 75 days (RR, 10.13; 95% CI, 1.76-58.23; P = 0.02) were associated with treatment failure. On multivariable analysis, positive margins (RR, 7.72; 95% CI, 2.71-22.01; P < 0.001) and immunosuppression (RR, 6.45; 95% CI, 2.42-17.20; P = 0.01) remained associated with treatment failure.
Recurrence rates after exclusive surgical treatment of M. ulcerans disease in an Australian cohort are high, with increased rates associated with immunosuppression or positive histological margins.
描述分枝杆菌溃疡感染单纯手术后复发的危险因素。
设计、地点和参与者：这是一项对 1998 年 1 月 1 日至 2011 年 12 月 31 日期间在巴旺健康中心（一家三级转诊医院）仅接受手术治疗的所有分枝杆菌溃疡病例进行的前瞻性观察队列研究。使用随机效应泊松回归模型评估治疗失败的发生率和关联因素。
治疗失败的发生率和与治疗失败相关因素的率比（RR）。
192 例分枝杆菌溃疡感染患者中，50 例（26%）接受了单纯手术治疗。中位年龄为 65.0 岁（2013 年四分位间距 [IQR]，45.5-77.7 岁），中位症状持续时间为 46 天（IQR，26-90 天）。16 例患者中有 20 例复发。对于首发病变，100 人-2013 年的复发发病率为 41.8（95%CI，25.6-68.2），复发中位时间为 50 天（IQR，30-171 天）。在 13 例病例中，复发发生在距原病变≤3 cm 处，在 9 例病例中，复发发生在距原病变>3 cm 处。单变量分析显示，年龄≥60 岁（RR 13.84；95%CI，2.21-86.68；P<0.01）、远端病变（RR，20.43；95%CI，1.97-212.22；P<0.01）、组织学阳性边缘（RR，21.02；95%CI，5.51-80.26；P<0.001）、免疫抑制（RR，17.97；95%CI，4.17-77.47；P<0.01）和症状持续时间>75 天（RR，10.13；95%CI，1.76-58.23；P=0.02）与治疗失败相关。多变量分析显示，阳性边缘（RR，7.72；95%CI，2.71-22.01；P<0.001）和免疫抑制（RR，6.45；95%CI，2.42-17.20；P=0.01）仍与治疗失败相关。
在澳大利亚队列中，分枝杆菌溃疡单纯手术后复发率较高，免疫抑制或组织学阳性边缘与复发率增加有关。
