Atif Muhammad, Bashir Arslan, Ahmad Nafees, Fatima Razia Kaneez, Saba Sehar, Scahill Shane
Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan.
Faculty of Pharmacy and Health Sciences, University of Balochistan, Quetta, Pakistan.
BMC Infect Dis. 2017 Sep 29;17(1):655. doi: 10.1186/s12879-017-2746-5.
Interim treatment outcomes at 6-months for multidrug-resistant tuberculosis (MDR-TB) treatment are among the most basic performance monitoring and key evaluation indicators in the Stop and End TB strategy of the World Health Organization (WHO). Therefore, this study was conducted to evaluate the interim treatment outcomes of MDR-TB patients in Pakistan.
This study was conducted at the Programmatic Management Unit for Drug-resistance TB (PMDT) site of the National Tuberculosis Program (NTP), Pakistan. It is located in the Chest Disease Unit (CDU) of the Bahawal Victoria Hospital (BVH), Bahawalpur, Punjab, Pakistan. Data was collected between April 1, 2014 and December 31, 2015. The medical records, Electronic Nominal Recording Reporting System (ENRS) data and MRD-TB notification forms of the MDR-TB patients registered at the PMDT site were reviewed to obtain data. For reporting and calculation of interim treatment outcomes, standardized WHO methodology was adopted. Simple logistic regression analysis was used to examine the possible association between the dependent variable (i.e. unsuccessful interim treatment outcome) and selected socio-demographic and clinical variables.
A total of 100 drug-resistant TB (DR-TB) patients (all types) were registered during the study period. Out of these, 80 were MDR-TB patients for whom interim results were available. Out of the 80 MDR-TB cases, 48 (60%) were classified under the successful interim treatment outcome category. The remaining 40% had unsuccessful 6-month treatment outcomes and 12 (15%) patients died, while nine (11.3%) were lost to follow-up by six months. The final predictors of unsuccessful interim treatment outcomes were; being resistant to ofloxacin (AOR 3.23, 95% CI 0.96-10.89; p-value = 0.04), having above normal baseline serum creatinine levels (AOR 6.49, 95% CI 1.39-30.27; p-value = 0.02), and being culture positive at the second month of treatment (AOR 6.94, 95% CI 2-24.12; p-value = 0.01).
Despite free treatment and programmatic efforts to ensure patient adherence, the high rate of unsuccessful interim treatment outcomes is concerning. The identified risk factors for unsuccessful interim treatment outcomes in the current study provides clinicians an opportunity to identify high-risk patients and ensure enhanced clinical management and greater treatment success rates.
耐多药结核病（MDR-TB）治疗6个月时的中期治疗结果是世界卫生组织（WHO）终止结核病和终结结核病战略中最基本的绩效监测和关键评估指标之一。因此，本研究旨在评估巴基斯坦耐多药结核病患者的中期治疗结果。
本研究在巴基斯坦国家结核病规划（NTP）的耐药结核病规划管理单位（PMDT）开展。该单位位于巴基斯坦旁遮普省巴哈瓦尔布尔市巴哈瓦尔维多利亚医院（BVH）的胸科病房（CDU）。研究收集了2014年4月1日至2015年12月31日期间的数据。查阅了在PMDT单位登记的耐多药结核病患者的病历、电子名义记录报告系统（ENRS）数据和耐多药结核病通报表以获取数据。对于中期治疗结果的报告和计算，采用了WHO的标准化方法。使用简单逻辑回归分析来检验因变量（即中期治疗结果不成功）与选定的社会人口学和临床变量之间可能存在的关联。
在研究期间共登记了100例耐药结核病（DR-TB）患者（所有类型）。其中，80例为有中期结果的耐多药结核病患者。在这80例耐多药结核病病例中，48例（60%）被归类为中期治疗结果成功类别。其余40%的患者6个月治疗结果不成功，12例（15%）患者死亡，9例（11.3%）患者在6个月时失访。中期治疗结果不成功的最终预测因素为：对氧氟沙星耐药（比值比[AOR] 3.23，95%置信区间[CI] 0.96 - 10.89；p值 = 0.04）、基线血清肌酐水平高于正常（AOR 6.49，95% CI 1.39 - 30.27；p值 = 0.02）以及治疗第2个月时培养阳性（AOR 6.94，95% CI 2 - 24.12；p值 = 0.01）。
尽管有免费治疗和为确保患者依从性所做的规划努力，但中期治疗结果不成功的高比例令人担忧。本研究中确定的中期治疗结果不成功的风险因素为临床医生提供了识别高危患者的机会，以确保加强临床管理并提高治疗成功率。
