Division of Epidemiology and Biostatistics, Stellenbosch University, Tygerberg, South Africa.
Elizabeth Glaser Pediatric Aids Foundation, Maseru, Lesotho.
Sci Rep. 2020 Feb 5;10(1):1917. doi: 10.1038/s41598-020-58690-4.
The Lesotho guidelines for the management of drug-resistant tuberculosis (TB) recommend initiation of patients diagnosed with rifampicin resistant (RR)-TB on a standardized drug resistant regimen while awaiting confirmation of rifampicin resistant TB (RR-TB) and complete drug susceptibility test results. Review of diagnostic records between 2014 and 2016 identified 518 patients with RR-TB. Only 314 (60.6%) patients could be linked to treatment records at the Lesotho MDR hospital. The median delay in treatment initiation from the availability of Xpert MTB/RIF assay result was 12 days (IQR 7-19). Only 32% (101) of patients had a documented first-line drug resistant test. MDR-TB was detected in 56.4% of patients while 33.7% of patients had rifampicin mono-resistance. Only 7.4% of patients assessed for second-line resistance had a positive result (resistance to fluoroquinolone). Treatment success was 69.8%, death rate was 28.8%, loss to follow up was 1.0%, and 0.4% failed treatment. Death was associated with positive or unavailable sputum smear at the end of first month of treatment (Fisher exact p < 0.001) and older age (p = 0.007). Urgent attention needs to be given to link patients with RR-TB to care worldwide. The association of death rate with positive sputum smear at the end of the first month of treatment should trigger early individualization of treatment.
莱索托耐多药结核病（TB）管理指南建议对确诊为利福平耐药（RR）-TB 的患者在等待利福平耐药 TB（RR-TB）确认和完整药物敏感性测试结果的同时，开始使用标准化耐药方案进行治疗。对 2014 年至 2016 年的诊断记录进行审查，发现了 518 例 RR-TB 患者。仅有 314 例（60.6%）RR-TB 患者可与莱索托 MDR 医院的治疗记录相关联。从 Xpert MTB/RIF 检测结果可用到开始治疗的中位数延迟为 12 天（IQR 7-19）。仅有 32%（101）的患者有记录的一线耐药检测。56.4%的患者检测出 MDR-TB，而 33.7%的患者存在利福平单耐药。仅 7.4%的评估二线耐药的患者结果呈阳性（对氟喹诺酮类药物耐药）。治疗成功率为 69.8%，死亡率为 28.8%，失访率为 1.0%，0.4%的患者治疗失败。死亡与治疗开始第一个月末痰液涂片阳性或无法获得（Fisher 确切概率 p<0.001）和年龄较大（p=0.007）有关。全世界都需要紧急关注将 RR-TB 患者与治疗联系起来。治疗开始第一个月末痰液涂片阳性与死亡率之间的关联应促使尽早对治疗进行个体化。
