Goswami Avranil, Chakraborty Urmita, Mahapatra Tanmay, Mahapatra Sanchita, Mukherjee Tapajyoti, Das Shibali, Das Aritra, Dey Subir Kumar, Ray Sudhin, Bhattacharya Basudev, Pal Nishith Kumar
Institute of Postgraduate Medical Education & Research, Kolkata, India.
Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America.
PLoS One. 2014 Oct 7;9(10):e109563. doi: 10.1371/journal.pone.0109563. eCollection 2014.
Worldwide highest number of new pulmonary tuberculosis (PTB) cases, was reported from India in 2012. Adverse treatment outcomes and emergence of drug resistance further complicated the prevailing scenario owing to increased duration, cost and toxicity associated with the treatment of drug-resistant cases. Hence to reinforce India's fight against TB, identification of the correlates of adverse treatment outcomes and drug resistance, seemed critical.
To estimate the associations between diagnostic findings, patient types (based on treatment outcomes), drug resistance and socio-demographic characteristics of PTB patients, a cross-sectional study was conducted in two tertiary-care hospitals in Kolkata between April 2010 and March 2013. Altogether, 350 consenting Mycobacterium tuberculosis sputum-culture positive PTB patients were interviewed about their socio-demographic background, evaluated regarding their X-ray findings (minimal/moderately advanced/far advanced/cavities), sputum-smear positivity, and treatment history/outcomes (new/defaulter/relapse/treatment-failure cases). Multiple-allele-specific polymerase chain reaction (MAS-PCR) was conducted to diagnose drug resistance.
Among all participants, 31.43% were newly diagnosed, while 44%, 15.43% and 9.14% patients fell into the categories of relapsed, defaulters and treatment-failures, respectively. 12.29% were multi-drug-resistant (MDR: resistant to at least isoniazid and rifampicin), 57.71% had non-MDR two-drug resistance and 12% had single-drug resistance. Subjects with higher BMI had lower odds of being a relapse/defaulter/treatment failure case while females were more likely to be defaulters and older age-groups had more relapse. Elderly, females, unmarried, those with low BMI and higher grade of sputum-smear positivity were more likely to have advanced X-ray features. Higher grade of sputum-smear positivity and advanced chest X-ray findings were associated with relapse/treatment-failures. Elderly, unmarried, relapse/defaulter/treatment-failure cases had higher odds and those with higher BMI and moderately/far advanced X-ray findings had lower odds of having MDR/non-MDR two-drug resistant PTB.
Targeted intervention and appropriate counseling are needed urgently to prevent adverse treatment outcomes and development of drug resistance among PTB patients in Kolkata.
2012年，印度报告的全球新增肺结核（PTB）病例数最多。由于耐多药病例治疗时间延长、成本增加和毒性增大，不良治疗结果和耐药性的出现使当前情况更加复杂。因此，为加强印度抗击结核病的斗争，确定不良治疗结果和耐药性的相关因素似乎至关重要。
为评估诊断结果、患者类型（基于治疗结果）、耐药性与PTB患者社会人口学特征之间的关联，2010年4月至2013年3月期间在加尔各答的两家三级医院开展了一项横断面研究。总共对350名同意参与的结核分枝杆菌痰培养阳性的PTB患者进行了访谈，了解他们的社会人口学背景，评估他们的X线检查结果（轻度/中度进展/重度进展/有空洞）、痰涂片阳性情况以及治疗史/结果（新发病例/违约者/复发者/治疗失败者）。采用多等位基因特异性聚合酶链反应（MAS-PCR）诊断耐药性。
在所有参与者中，31.43%为新诊断病例，而44%、15.43%和9.14%的患者分别属于复发、违约和治疗失败类别。12.29%为多重耐药（MDR：至少对异烟肼和利福平耐药），57.71%有非MDR双药耐药，12%有单药耐药。体重指数较高的受试者成为复发/违约/治疗失败病例的几率较低，而女性更有可能成为违约者，年龄较大的人群复发率更高。老年人、女性、未婚者、体重指数低和痰涂片阳性程度较高的人更有可能有进展期X线特征。痰涂片阳性程度较高和胸部X线检查结果进展期与复发/治疗失败有关。老年人、未婚者、复发/违约/治疗失败病例患MDR/非MDR双药耐药PTB的几率较高，而体重指数较高和X线检查结果为中度/重度进展期的人几率较低。
迫切需要进行有针对性的干预和适当的咨询，以预防加尔各答PTB患者出现不良治疗结果和耐药性。
