KNCV Tuberculosis Foundation, Country Office, Dushanbe.
USAID TB Control Project, Dushanbe.
Int J Tuberc Lung Dis. 2019 Mar 1;23(3):331-336. doi: 10.5588/ijtld.18.0311.
Tajikistan is among the 30 countries with the highest multidrug-resistant tuberculosis (MDR-TB) burden.
To investigate the risk factors for unfavourable treatment outcomes among rifampicin-resistant (RR)/MDR-TB patients.
Retrospective medical chart review of RR/MDR-TB patients enrolled for treatment in 2012-2013.
Of 601 RR/MDR-TB patients, 58 (9.7%) had pre-extensively drug-resistant TB (pre-XDR-TB; i.e., MDR-TB with additional resistance to a fluoroquinolone or second-line injectable agent) and 45 (8%) had XDR-TB (MDR-TB with additional resistance to both). Treatment failure and death were reported in respectively 40 (7%) and 89 (15%) cases; 60 (10%) patients were lost to follow-up (LTFU). In multivariable analysis, treatment failure was associated with pre-XDR-TB (adjusted odds ratio [aOR] 3.67, 95%CI 1.47-9.18) or XDR-TB (aOR 8.61, 95%CI 3.48-21.34). Death was associated with age >45 years vs. <25 years (aOR 3.47, 95%CI 1.68-7.19) and no record of any adverse event during treatment (aOR 2.55, 95%CI 1.48-4.39). Changing place of residence during treatment was an independent predictor of LTFU (aOR 4.61, 95%CI 2.41-8.8).
Our findings highlight the need for 1) the use of regimens with new anti-tuberculosis drugs; 2) good handover of TB patients and 3) effective tracing mechanisms if patients change a place of residence to prevent LTFU.
塔吉克斯坦是耐多药结核病（MDR-TB）负担最高的 30 个国家之一。
调查利福平耐药（RR）/耐多药结核病（MDR-TB）患者不良治疗结局的危险因素。
对 2012-2013 年接受治疗的 RR/MDR-TB 患者进行回顾性病历审查。
在 601 例 RR/MDR-TB 患者中，58 例（9.7%）患有预广泛耐药结核病（pre-XDR-TB；即 MDR-TB 对氟喹诺酮类药物或二线注射剂的耐药性增加），45 例（8%）患有广泛耐药结核病（XDR-TB；MDR-TB 对氟喹诺酮类药物和二线注射剂的耐药性均增加）。分别有 40 例（7%）和 89 例（15%）患者报告治疗失败和死亡；60 例（10%）患者失访（LTFU）。多变量分析显示，治疗失败与预 XDR-TB（调整后的优势比[aOR]3.67，95%CI 1.47-9.18）或 XDR-TB（aOR 8.61，95%CI 3.48-21.34）相关。死亡与年龄>45 岁与<25 岁（aOR 3.47，95%CI 1.68-7.19）和治疗期间无任何不良事件记录（aOR 2.55，95%CI 1.48-4.39）相关。治疗期间居住地发生变化是 LTFU 的独立预测因素（aOR 4.61，95%CI 2.41-8.8）。
我们的研究结果强调了以下几点的必要性：1）使用含有新抗结核药物的方案；2）结核病患者的妥善交接；3）如果患者改变居住地，需要采取有效的追踪机制，以防止失访。
