Programmatic Management of Drug Resistant TB Pulmonology, Lady Reading Hospital Peshawar, Peshawar, Pakistan.
Gomal Centre of Biochemistry and Biotechnology, Gomal University, Dera Ismail Khan, Khyber Pakhtunkhwa, Pakistan; Programmatic Management of Drug-Resistant TB Unit, TB Culture Laboratory, Mufti Mehmood Memorial Teaching Hospital, Dera Ismail Khan, Khyber Pakhtunkhwa, Pakistan.
Clin Microbiol Infect. 2018 Jun;24(6):612-617. doi: 10.1016/j.cmi.2017.09.012. Epub 2017 Sep 29.
We aimed to determine the characteristics, treatment outcomes and risk factors for poor treatment outcomes among multidrug-resistant (MDR) tuberculosis (TB) patients in Khyber Pakhtunkhwa province, Pakistan.
A retrospective cohort study including all patients with MDR-TB who sought care at the MDR-TB unit in Peshawar was conducted between January 2012 and April 2014. Patients were followed until an outcome of TB treatment was recorded as successful (cured or completed) or unsuccessful. Binary logistic regression was used to identify predictors of poor outcome, i.e. unsuccessful treatment outcomes.
Overall, 535 patients were included. The proportion of female subjects was relatively higher (n = 300, 56.1%) than male subjects. The mean (standard deviation) age of patients was 30.37 (14.09) years. Of 535 patients for whom treatment outcomes were available, 402 (75.1%) were cured, 4 (0.7%) completed therapy, 34 (6.4%) had disease that failed to respond to therapy, 93 (17.4%) died and two (0.4%) defaulted; in total, 129 (24.1%) had an unsuccessful outcome. We found three significant predictors of unsuccessful treatment during multivariate logistic regression: being married (odds ratio (OR) = 2.17, 95% confidence interval (CI) 1.01, 4.66), resistance to second-line drugs (OR = 2.61, 95% CI 1.61, 4.21) and presence of extensively drug-resistant TB (OR = 7.82, 95% CI 2.90, 21.07).
Approximately 75% of the treatment success rate set by the Global Plan to Stop TB was achieved. Resistance to second-line drugs and presence of extensively drug-resistant TB are the main risk factors for poor treatment outcomes.
本研究旨在确定巴基斯坦开伯尔-普赫图赫瓦省耐多药结核病（MDR-TB）患者的特征、治疗结局和不良结局的危险因素。
本回顾性队列研究纳入了 2012 年 1 月至 2014 年 4 月期间在白沙瓦耐多药结核病（MDR-TB）病房寻求治疗的所有 MDR-TB 患者。患者随访至结核病治疗结果记录为成功（治愈或完成）或失败。采用二项逻辑回归分析确定不良结局（即治疗失败）的预测因素。
共纳入 535 例患者。女性患者（n=300，56.1%）多于男性患者。患者的平均（标准差）年龄为 30.37（14.09）岁。535 例患者中，有 402 例（75.1%）治愈，4 例（0.7%）完成治疗，34 例（6.4%）治疗无效，93 例（17.4%）死亡，2 例（0.4%）失访，总共有 129 例（24.1%）治疗结局不良。多变量逻辑回归分析发现，已婚（比值比（OR）=2.17，95%置信区间（CI）1.014.66）、二线药物耐药（OR=2.61，95%CI 1.614.21）和广泛耐药结核病（OR=7.82，95%CI 2.90~21.07）是治疗失败的三个显著预测因素。
本研究达到了全球结核病遏制计划设定的约 75%的治疗成功率。二线药物耐药和广泛耐药结核病是治疗结局不良的主要危险因素。
