Saifullah Amna, Mallhi Tauqeer Hussain, Khan Yusra Habib, Iqbal Muhammad Shahid, Alotaibi Nasser Hadal, Alzarea Abdulaziz Ibrahim, Rasheed Maria
Institute of Pharmacy, Lahore College for Women University, Lahore, Punjab, Pakistan.
Current Affiliation: Department of Pharmacy, University of Lahore, Chenab Campus, Gujrat, Pakistan.
PeerJ. 2021 Mar 18;9:e10826. doi: 10.7717/peerj.10826. eCollection 2021.
Drug resistant tuberculosis (DR-TB) infringes substantial burden in terms of longer treatment duration, morbidity and mortality. Timely identification of patients at risks of DR-TB will aid individualized treatment. Current study was aimed to ascertain several factors associated with DR-TB among patients attending a tertiary care hospital.
This retrospective study was conducted among patients with confirmed diagnosis of DR-TB and drug susceptible TB (DS-TB) seeking medical care from a tertiary care hospital during 2014-2019. The types of DR-TB included were rifampicin resistant tuberculosis (RR-TB), Multidrug resistant tuberculosis (MDR-TB) and extensively drug resistant tuberculosis (XDR-TB). Appropriate statistical methods were implied to evaluate the factors associated with DR-TB.
Out of 580 patients, DS-TB was diagnosed in 198 (34.1%) patients while DR-TB was present in 382 patients. Of resistance cases, RR-TB, MDR-TB and XDR-TB were diagnosed in 176 (30.3%), 195 (33.6%) and 11 (1.9%) patients, respectively. Significant differences ( < 0.05) in demographics and clinico-laboratory characteristics were observed between patients with DS-TB and DR-TB. Logistic regression analysis revealed age ≤38 years (OR: 2.5), single marital status (OR: 11.1), tobacco use (OR: 2.9), previous treatment (OR: 19.2), treatment failure (OR: 9.2) and cavity on chest X-ray (OR: 30.1) as independent risk factors for MDR-TB. However, XDR-TB was independently associated with age group of ≤38 years (OR: 13.6), students (OR: 13.0), previous treatment (OR: 12.5), cavity on chest X-ray (OR: 59.6). The independent risk factors associated with RR-TB are age ≤38 years (OR: 2.8), females (OR: 5.7), unemployed (OR: 41.5), treatment failure (OR: 4.9), previous treatment (OR: 38.2) and cavity on chest X-ray (OR: 4.3). ROC curve analysis accentuate the excellent predictive accuracy of all logistic regression models as shown by AUC (0.968, < 0.001) for MDR-TB, AUC (0.941, < 0.001) for XDR-TB and AUC (0.962, < 0.001) for RR-TB.
Current study demonstrates a sizeable extent of resistant cases among pulmonary TB patients. This study presaged significant risk of DR-TB among females, young adults, unemployed, smokers, patients with previous treatment failure and cavitation on chest X-ray. Timely identification of high risk patients will give pronounced advantages regarding appropriate choices of prevention, treatment and disease control.
耐药结核病（DR-TB）在治疗时间延长、发病率和死亡率方面带来了巨大负担。及时识别有DR-TB风险的患者将有助于个体化治疗。当前研究旨在确定在一家三级医院就诊的患者中与DR-TB相关的几个因素。
这项回顾性研究是在2014年至2019年期间在一家三级医院寻求医疗护理的确诊DR-TB和药物敏感结核病（DS-TB）患者中进行的。所包括的DR-TB类型为耐利福平结核病（RR-TB）、耐多药结核病（MDR-TB）和广泛耐药结核病（XDR-TB）。采用适当的统计方法来评估与DR-TB相关的因素。
在580例患者中，198例（34.1%）被诊断为DS-TB，382例患者存在DR-TB。在耐药病例中，分别有176例（30.3%）、195例（33.6%）和11例（1.9%）患者被诊断为RR-TB、MDR-TB和XDR-TB。DS-TB患者和DR-TB患者在人口统计学和临床实验室特征方面存在显著差异（<0.05）。逻辑回归分析显示，年龄≤38岁（比值比：2.5）、单身婚姻状况（比值比：11.1）、吸烟（比值比：2.9）、既往治疗史（比值比：19.2）、治疗失败（比值比：9.2）和胸部X线有空洞（比值比：30.1）是MDR-TB的独立危险因素。然而，XDR-TB与年龄≤38岁组（比值比：13.6）、学生（比值比：13.0）、既往治疗史（比值比：12.5）、胸部X线有空洞（比值比：59.6）独立相关。与RR-TB相关的独立危险因素是年龄≤38岁（比值比：2.8）、女性（比值比：5.7）、失业（比值比：41.5）、治疗失败（比值比：4.9）、既往治疗史（比值比：38.2）和胸部X线有空洞（比值比：4.3）。ROC曲线分析表明，所有逻辑回归模型均具有出色的预测准确性，MDR-TB的AUC为（0.968，<0.001），XDR-TB的AUC为（0.941，<0.001），RR-TB的AUC为（0.962，<0.001）。
当前研究表明肺结核患者中耐药病例的比例相当大。这项研究预示着女性、年轻人、失业者、吸烟者、既往有治疗失败史以及胸部X线有空洞的患者发生DR-TB的风险显著。及时识别高危患者将在预防、治疗和疾病控制的适当选择方面带来明显优势。
