Institute for Infection and Immunity, St. George's University of London, London SW17 0RE, United Kingdom; Clinical Infection Unit, St George's Healthcare NHS Trust, London SW17 0QT, United Kingdom.
Division of Medicine, Imperial College London, United Kingdom.
J Infect. 2017 Mar;74(3):260-271. doi: 10.1016/j.jinf.2016.12.005. Epub 2016 Dec 18.
Detailed information regarding treatment practices and outcomes of MDR-TB treatment in the UK is required as a baseline for care improvements.
100 consecutive cases between 2008 and 2014 were reviewed retrospectively at 4 MDR-TB treatment centres in England to obtain information on drug treatment choices, hospital admission duration and outcomes for MDR-TB.
Initial hospital admission was long, median 62.5 (IQR 20-106, n = 92) days, and 13% (12/92) of patients lost their home during this period. Prolonged admission was associated with pulmonary cases, cavities on chest radiograph, a public health policy of waiting for sputum culture conversion (CC) and loss of the patient's home. Sputum CC occurred at a median of 33.5 (IQR 16-55, n = 46) days. Treatment success was high (74%, 74/100) and mortality low (1%, 1/100). A significant proportion of the cohort had "neutral" results due to deportation and transfer overseas (12%, (12/100)). 14% (14/100) had negative outcomes for which poor adherence was the main reason (62%, 9/14).
Successful outcome is common in recognised centres and limited by adherence rather than microbiological failure. Duration of hospital admission is influenced by lack of suitable housing and some variation in public health practice. Wider access to long-term assisted living facilities could improve completion rates.
需要详细了解英国耐多药结核病（MDR-TB）治疗的治疗方法和结果，以此作为改善治疗的基准。
在英格兰的 4 个 MDR-TB 治疗中心回顾性分析了 2008 年至 2014 年间的 100 例连续病例，以获取有关药物治疗选择、住院时间和 MDR-TB 结局的信息。
初始住院时间长，中位数为 62.5（IQR 20-106，n=92）天，在此期间有 13%（12/92）的患者失去了家园。住院时间延长与肺部病例、胸部 X 光片有空腔、等待痰培养转化（CC）和患者失去家园的公共卫生政策有关。痰 CC 中位数为 33.5（IQR 16-55，n=46）天。治疗成功率高（74%，74/100），死亡率低（1%，1/100）。由于驱逐出境和转移到海外，该队列中有相当一部分（12%，12/100）结果呈“中性”。14%（14/100）的结果为负面，其中主要原因是药物依从性差（62%，9/14）。
在公认的中心，成功的结果很常见，并且受到药物依从性而不是微生物学失败的限制。住院时间的长短受缺乏合适住房和公共卫生实践的一些差异的影响。扩大获得长期辅助生活设施的机会可以提高完成率。
