Clinic of Infectious Diseases, University of Bari "Aldo Moro", Department of Biomedical Sciences and Human Oncology, Bari, IT.
Microbiology and Virology Unit, University of Bari, University Hospital Policlinico, Bari, IT.
Ann Glob Health. 2022 Apr 26;88(1):26. doi: 10.5334/aogh.3677. eCollection 2022.
The COVID-19 pandemic has undone years of progress in providing essential TB services and controlling the TB burden. Italy, a low TB burden country, has an incidence of 7.1 cases per 100,000 people. To control the TB spreading in Italy is critical to investigate the characteristics of patients with the worst outcomes and the highest risk of adverse events related to antituberculosis therapy. Therefore, we conducted a large retrospective study in TB patients admitted to the Clinic of Infectious Diseases University of Bari, Italy, in order to describe the clinical presentation and the factors associated with adverse events and outcomes.
We retrospectively evaluated the patients admitted to the Clinic of Infectious Diseases from January 2013 to 15 December 2021. We stratified our cohort into two groups: <65 years of age and ≥65 years in order to assess any differences between the two groups. Two logistic regression models were implemented considering the dependent variables as: (I) the adverse events; and (II) the unsuccessful treatments.
In total, 206 consecutive patients [60% (n = 124) M, median age 39 years, range 16-92] were diagnosed and admitted with TB at Clinic of Infectious Diseases. Of the whole sample, 151 (74%) were <65 years and 55 (26%) were ≥65. Statistically significant differences between the two groups were detected ( < 0.05) for nationality ( 0.01), previous contact with TB patient ( = 0.00), type of TB ( = 0.00), unsuccessful treatment ( = 0.00), length of hospitalization ( = 0.02) and diagnostic delay (p-value = 0.01). Adverse events related to TB drug regimen were reported in 24% ( = 49). Age < 65 years (O.R. = 3.91; 95% CI 1.72-4.21), non-Italian nationality (O.R. = 4.45; 95% CI 2.22-4.98.), homeless (O.R. = 3.23; 95% CI 2.58-4.54), presence of respiratory symptoms (O.R. = 1.23; 95% CI 1.10-1.90), diagnostic delay (O.R = 2.55; 95% CI 1.98-3.77) resulted associated with unsuccessful treatment outcome (death, failure or lost to follow up). Finally, age < 65 years (O.R. = 1.73; 95% CI 1.31-2.49), presence of pulmonary TB (O.R. = 1.15; 95% CI 1.02-1.35), length of hospitalization (O.R. = 1.82; 95% CI 1.35-2.57) and TB culture positive (O.R. = 1.35; 95% CI 1.12-1.82) were associated with adverse events in our populations.
The pharmacological approach alone seems insufficient to treat and cure a disease whose ethiopathogenesis is not only due to the , but also to the poverty or the social fragility. Our data suggest that young foreigners, the homeless, and the people with low social and economic status are at higher risk of an unfavorable outcome in low incidence TB countries. Targeted actions to support this highly vulnerable population both in terms of outcome and occurrence of adverse events are needed.
COVID-19 大流行使多年来提供基本结核病服务和控制结核病负担的工作付诸东流。意大利是一个结核病负担较低的国家，发病率为每 10 万人 7.1 例。控制意大利结核病的传播对于调查与抗结核治疗相关的不良事件和最高风险的患者的特征至关重要。因此，我们对意大利巴里传染病诊所收治的结核病患者进行了一项大型回顾性研究，以描述临床表现以及与不良事件和结局相关的因素。
我们回顾性评估了 2013 年 1 月至 2021 年 12 月 15 日期间在传染病诊所收治的患者。我们将队列分为两组：<65 岁和≥65 岁，以评估两组之间的任何差异。实施了两个逻辑回归模型，将依赖变量视为：（I）不良事件；（II）治疗失败。
在传染病诊所共诊断并收治了 206 例连续患者[60%（n=124）为男性，中位年龄 39 岁，范围 16-92]。在整个样本中，151 例（74%）<65 岁，55 例（26%）≥65 岁。两组之间存在统计学显著差异（<0.05），包括国籍（<0.01）、与结核病患者有过接触（=0.00）、结核病类型（=0.00）、治疗失败（=0.00）、住院时间（=0.02）和诊断延误（p 值=0.01）。报告了 24%（n=49）的与抗结核药物方案相关的不良事件。年龄<65 岁（OR=3.91；95%CI 1.72-4.21）、非意大利国籍（OR=4.45；95%CI 2.22-4.98）、无家可归（OR=3.23；95%CI 2.58-4.54）、存在呼吸道症状（OR=1.23；95%CI 1.10-1.90）、诊断延误（OR=2.55；95%CI 1.98-3.77）与治疗失败结局（死亡、失败或失访）相关。最后，年龄<65 岁（OR=1.73；95%CI 1.31-2.49）、存在肺结核（OR=1.15；95%CI 1.02-1.35）、住院时间（OR=1.82；95%CI 1.35-2.57）和结核培养阳性（OR=1.35；95%CI 1.12-1.82）与我们人群中的不良事件相关。
仅采用药物治疗似乎不足以治疗和治愈一种疾病，其发病机制不仅与细菌有关，还与贫困或社会脆弱性有关。我们的数据表明，在结核病发病率较低的国家，年轻外国人、无家可归者和社会经济地位较低的人更有可能出现不良结局。需要采取有针对性的行动，以支持这一高度脆弱的人群，无论是在结局还是不良事件的发生方面。
