Republican Klaipeda hospital, Tuberculosis Branch, Klaipeda.
World Health Organization, Regional Office for Europe, Copenhagen.
Monaldi Arch Chest Dis. 2021 Jan 14;91(1). doi: 10.4081/monaldi.2021.1675.
The global proportion of successful treatment outcomes of Multidrug-Resistant/Rifampicin-Resistant Tuberculosis (MDR/RR-TB) remains unacceptably low. Time to culture conversion is important in making treatment-related decisions and is used as an interim predictor of pulmonary MDR/RR-TB treatment success. No previous studies have been conducted to assess determinants of time to culture conversion for MDR/RR-TB patients in Lithuania. Secondary analysis of data of culture-positive MDR/RR-TB patients, treated in Republican Klaipeda Hospital between 1st July 2016 and 1st July 2019 was performed. Culture conversion was defined as two consecutive negative cultures on solid media submitted at least 30 days apart. Factors associated with culture conversion were estimated by crude and multivariable Cox regression accounting for competing risks. In total, 115 consecutive patients starting treatment were included in the study. Of them, the majority was male (86/115; 74.8%) with a mean age of 48 (standard deviation (SD) ±12) years and Human Immunodeficiency Virus (HIV) negative (105/115; 91.3%). Nearly two-thirds (72/115; 62.6%) had XDR (extensive drug resistance) or MDR/RR-TB with additional resistance to second-line injectables or fluoroquinolones. Of 115 culture-positive patients at baseline, 103 (89.6%) patients achieved culture conversion during 12 months of treatment. The median time to culture conversion was 1.1 months (interquartile range: 0.9-1.8). Patients aged ≥60 years compared with <40 years [adjusted hazard ration (aHR): 0.40, 95% confidence interval (CI): 0.18-0.86], smokers (aHR: 0.39, 95% CI: 0.2-0.73), patients with positive sputum smear microscopy at baseline (aHR: 0.40, 95% CI: 0.25-0.63), cavities on initial chest X-ray (aHR: 0.56, 95% CI: 0.35-0.88) and resistance to at least one fluoroquinolone drug (aHR: 0.52, 95% CI: 0.32-0.84) were slower to culture convert. In conclusion, we recommend providing additional counseling, treatment adherence interventions and scale up the use of new and repurposed TB drugs to patient groups at risk of worse interim treatment outcome: patients aged 60 and above, with resistance to fluoroquinolones, smear-positive, smokers, or with signs of extensive disease evident on initial chest radiography.
全球耐多药/利福平耐药结核病（MDR/RR-TB）的治疗成功率仍然低得令人无法接受。培养物转换时间对于做出治疗相关决策很重要，并且可作为预测肺 MDR/RR-TB 治疗成功的中期指标。以前没有研究评估立陶宛 MDR/RR-TB 患者培养物转换时间的决定因素。对 2016 年 7 月 1 日至 2019 年 7 月 1 日在共和国克莱佩达医院接受治疗的培养阳性 MDR/RR-TB 患者的数据进行了二次分析。培养转换定义为至少相隔 30 天提交的两份连续阴性固体培养基培养物。通过考虑竞争风险的粗和多变量 Cox 回归来估计与培养转换相关的因素。共有 115 名开始治疗的连续患者纳入研究。其中，大多数为男性（86/115；74.8%），平均年龄为 48 岁（标准差（SD）±12），HIV 阴性（105/115；91.3%）。将近三分之二（72/115；62.6%）的患者具有 XDR（广泛耐药）或 MDR/RR-TB，并且对二线注射剂或氟喹诺酮类药物具有额外耐药性。在基线时的 115 名培养阳性患者中，有 103 名（89.6%）患者在 12 个月的治疗期间实现了培养转换。培养转换的中位时间为 1.1 个月（四分位距：0.9-1.8）。与<40 岁相比，年龄≥60 岁的患者[调整后的危险比（aHR）：0.40，95%置信区间（CI）：0.18-0.86]、吸烟者（aHR：0.39，95%CI：0.2-0.73）、基线时痰涂片镜检阳性的患者（aHR：0.40，95%CI：0.25-0.63）、初始胸部 X 射线检查有空腔的患者（aHR：0.56，95%CI：0.35-0.88）和至少对一种氟喹诺酮类药物耐药的患者（aHR：0.52，95%CI：0.32-0.84）培养物转换更慢。总之，我们建议向处于中期治疗结果风险较高的患者群体提供额外的咨询、治疗依从性干预措施，并扩大新的和重新定位的结核病药物的使用：年龄在 60 岁及以上、对氟喹诺酮类药物耐药、涂片阳性、吸烟者或初始胸部 X 射线检查显示广泛疾病迹象的患者。
