Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.
Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China.
Antimicrob Agents Chemother. 2018 Mar 27;62(4). doi: 10.1128/AAC.02259-17. Print 2018 Apr.
In high tuberculosis (TB)-burden countries such as China, the diagnosis of multidrug-resistant tuberculosis (MDR-TB) using conventional drug susceptibility testing (DST) takes months, making treatment delay inevitable. Poor outcomes of MDR-TB might be associated with delayed, even inappropriate, treatment. The purposes of this study were to investigate the time to MDR-TB treatment initiation and to assess the association between early treatment and treatment outcomes. Between April 2011 and December 2014, this population-based retrospective cohort study collected the demographic and clinical characteristics and the drug susceptibility profiles of all registered MDR-TB patients in Shanghai, China. The dates of TB and MDR-TB diagnoses, DST performance, and treatment initiation were extracted to calculate the times to treatment. In total, 284 of 346 MDR-TB patients were eligible for analysis, and 68.3% (194/284) had favored outcomes. The median time to treatment initiation from TB diagnosis was 172 days among those with favored outcomes and 190 days among those with poor outcomes. Treatments initiated within 60 days after performing DST (odds ratio [OR], 2.56; 95% confidence interval [CI], 1.22 to 5.36) and empirical treatments (OR, 2.09; 95% CI, 1.01 to 4.32) were positively associated with favored outcomes. Substantial delays to MDR-TB treatment were observed when conventional DST was used. Early treatment predicted favored outcomes. Rapid diagnostic methods should be scaled up and improvements should be made in patient management and information linkage to reduce treatment delay.
在结核病（TB）负担较高的国家，如中国，使用传统药物敏感性测试（DST）诊断耐多药结核病（MDR-TB）需要数月时间，这使得治疗延误不可避免。MDR-TB 的不良结局可能与治疗延迟，甚至不适当有关。本研究的目的是调查 MDR-TB 治疗开始的时间，并评估早期治疗与治疗结局之间的关系。本基于人群的回顾性队列研究于 2011 年 4 月至 2014 年 12 月间收集了中国上海所有登记的 MDR-TB 患者的人口统计学和临床特征以及药物敏感性谱。提取了 TB 和 MDR-TB 诊断、DST 表现和治疗开始的日期，以计算治疗时间。共有 346 例 MDR-TB 患者中的 284 例符合分析条件，其中 68.3%（194/284）的患者结局良好。在结局良好的患者中，从 TB 诊断到开始治疗的中位时间为 172 天，而在结局不良的患者中为 190 天。在进行 DST 后 60 天内开始治疗（比值比 [OR]，2.56；95%置信区间 [CI]，1.22 至 5.36）和经验性治疗（OR，2.09；95%CI，1.01 至 4.32）与良好结局呈正相关。当使用传统 DST 时，观察到 MDR-TB 治疗存在明显的延迟。早期治疗预测了良好的结局。应扩大快速诊断方法的应用范围，并改进患者管理和信息链接，以减少治疗延误。
