University Clinical Research Center (UCRC)-SEREFO Laboratory, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali; Department of Pneumo-phtisiology, University Teaching Hospital of Point G, Bamako, Mali.
Northwestern University, Chicago, IL, USA.
Int J Infect Dis. 2019 Apr;81:149-155. doi: 10.1016/j.ijid.2019.02.004. Epub 2019 Feb 14.
MDR-TB is a major threat to global TB control. In 2015, 580,000 were treated for MDR-TB worldwide. The worldwide roll-out of GeneXpert MTB/RIF has improved diagnosis of MDR-TB; however, in many countries laboratories are unable to assess drug resistance and clinical predictors of MDR-TB could help target suspected patients. In this study, we aimed to determine the clinical factors associated with MDR-TB in Bamako, Mali.
We performed a cross-sectional study of 214 patients with presumed MDR-TB admitted to University of Bamako Teaching Hospital, Point-G between 2007 and 2016. We calculated crude and adjusted odds ratios for MDR-TB disease diagnosis using SPSS.
We found that age ≤40years (OR=2.56. 95% CI: 1.44-4.55), two courses of prior TB treatment (OR=3.25, 95% CI: 1.44-7.30), TB treatment failure (OR=3.82, 95% CI 1.82-7.79), sputum microscopy with 3+ bacilli load (OR=1.98, 95% CI: 1.13-3.48) and a history of contact with a TB patient (OR=2.48, 95% CI: 1.11-5.50) were significantly associated with confirmation of MDR-TB disease. HIV was not a risk factor for MDR-TB (aOR=0.88, 95% CI: 0.34-1.94).
We identified several risk factors that could be used to identify MDR-TB suspects and prioritize them for laboratory confirmation. Prospective studies are needed to understand factors associated with TB incidence and clinical outcomes of TB treatment and disease.
耐多药结核病（MDR-TB）是全球结核病控制的主要威胁。2015 年，全球有 58 万人接受了耐多药结核病治疗。GeneXpert MTB/RIF 的全球推出改善了耐多药结核病的诊断；然而，在许多国家，实验室无法评估耐药性，而耐多药结核病的临床预测因素可以帮助确定疑似患者。在这项研究中，我们旨在确定马里巴马科与耐多药结核病相关的临床因素。
我们对 2007 年至 2016 年间在巴马科大学教学医院 Point-G 住院的 214 例疑似耐多药结核病患者进行了横断面研究。我们使用 SPSS 计算了 MDR-TB 疾病诊断的粗比值比（OR）和调整比值比（aOR）。
我们发现，年龄≤40 岁（OR=2.56，95%CI：1.44-4.55）、两疗程先前的结核病治疗（OR=3.25，95%CI：1.44-7.30）、结核病治疗失败（OR=3.82，95%CI 1.82-7.79）、痰镜检有 3+杆菌负荷（OR=1.98，95%CI：1.13-3.48）和与结核病患者接触史（OR=2.48，95%CI：1.11-5.50）与 MDR-TB 疾病的确诊显著相关。HIV 不是 MDR-TB 的危险因素（aOR=0.88，95%CI：0.34-1.94）。
我们确定了一些可以用来识别耐多药结核病可疑病例并将其优先用于实验室确认的危险因素。需要前瞻性研究来了解与结核病发病率以及结核病治疗和疾病临床结果相关的因素。
