住院对结核病聚集风险的诊断影响。

Influence of Hospitalization upon Diagnosis on the Risk of Tuberculosis Clustering.

机构信息

Clinic of Infectious Diseases, AO San Gerardo, Monza (Italy).

Luigi Sacco Hospital, University of Milan (Italy).

出版信息

Mediterr J Hematol Infect Dis. 2013 Nov 20;5(1):e2013071. doi: 10.4084/MJHID.2013.071. eCollection 2013.

DOI:10.4084/MJHID.2013.071

PMID:24363886

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3867278/

Abstract

SETTING

Culture-positive tuberculosis (TB) diagnosed in the metropolitan area of Milan (Italy) over a 5-year period (1995-1999).

OBJECTIVE

To assess the impact of short-course hospitalization upon diagnosis on the overall risk of TB clustering.

DESIGN

Restriction fragment length polymorphism profiles with a similarity of 100% defined a cluster. Uni- and multivariable logistic regression models were performed to assess factors associated with clustering.

RESULTS

Among 1139 patients, 392 (34.4%) were hospitalized before or soon after diagnosis, 405 (35.6%) received domiciliary treatment since the diagnosis and 392 (30%) had no information about initial clinical management. One hundred fifteen molecular clusters involving 363 patients were identified. Using multivariable analysis, hospitalization was not significantly associated with clustering (OR 1.06, 95%CI 0.75-1.50, p=0.575). Subjects aged >65 years old (OR 0.60; 95CI%:0.37-0.95; p=0.016) and non-Italian born patients (OR 0.56; 95%CI:0.41-0.76; p<0.001) were running a lower risk of clustering. Conversely, HIV co-infected patients (OR 1.88, 95%CI:1.20-2.95, p=0.006) and those with MDR TB (OR 2.50, 95%CI:1.46-4.25, p=0.001) were significantly more likely to be involved in clusters.

CONCLUSION

In our cohort, domiciliary treatment was not associated with TB clustering. Expanding domiciliary treatment upon diagnosis appears as an advisable measure to reduce unnecessary costs for the health care system.

摘要

背景

1995-1999 年间在意大利米兰市区确诊的培养阳性结核病（TB）。

目的

评估短期住院治疗对总体结核聚集风险的影响。

设计

相似度为 100%的限制性片段长度多态性图谱定义了一个集群。采用单变量和多变量逻辑回归模型来评估与聚类相关的因素。

结果

在 1139 名患者中，392 名（34.4%）在诊断前或诊断后不久住院，405 名（35.6%）接受家庭治疗，392 名（30%）没有初始临床管理的信息。共发现涉及 363 名患者的 115 个分子簇。多变量分析显示，住院治疗与聚类无显著相关性（比值比 1.06，95%置信区间 0.75-1.50，p=0.575）。年龄>65 岁的患者（比值比 0.60；95%置信区间：0.37-0.95；p=0.016）和非意大利出生的患者（比值比 0.56；95%置信区间：0.41-0.76；p<0.001）的聚类风险较低。相反，HIV 合并感染的患者（比值比 1.88，95%置信区间：1.20-2.95，p=0.006）和耐多药结核病（MDR TB）患者（比值比 2.50，95%置信区间：1.46-4.25，p=0.001）更有可能参与聚类。