贡德尔大学综合专科医院耐多药结核病治疗结果及相关因素：一项十年回顾性研究
Multidrug-Resistant Tuberculosis Treatment Outcome and Associated Factors at the University of Gondar Comprehensive Specialized Hospital: A Ten-Year Retrospective Study.
作者信息
Belachew Teshome, Yaheya Seid, Tilahun Nehemia, Gebrie Eshet, Seid Rim, Nega Tilahun, Biset Sirak
机构信息
Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, University of Gondar, Gondar, Ethiopia.
School of Biomedical and Laboratory Sciences, University of Gondar, Gondar, Ethiopia.
出版信息
Infect Drug Resist. 2022 Jun 3;15:2891-2899. doi: 10.2147/IDR.S365394. eCollection 2022.
BACKGROUND
Multidrug-resistant tuberculosis (MDR-TB) remains a public health crisis and a health security threat worldwide. Poor public health infrastructure, inefficient infection control and mismanagement of TB treatment are among the reasons for the continuous emergence and spread of drug-resistant TB (DR-TB). The final treatment outcome is the most direct measurement of TB control programs. Therefore, this study sought to determine the proportions and predictors of TB treatment outcomes among MDR/RR-TB treated patients.
METHODS
A 10-year, 2011 to 2021, hospital-based retrospective cohort study was conducted at the University of Gondar Comprehensive Specialized Hospital. The records of 408 MDR-TB patients, 389 with treatment outcome and 19 on treatment, were collected using a structured checklist.
RESULTS
A total of 389 patients with a recorded MDR/RR-TB treatment outcome were included. The treatment success rate was 77.12%, with 58.35% cured and 18.76% treatment completed. The proportion of death rate, treatment default loss to follow-up, treatment failure, and unknown treatment outcome was 9.25%, 6.94%, 3.1%, and 3.6%, respectively. Regarding the patient category, the most successful treatment outcome (83.5%) came from patients diagnosed with relapse cases, followed by new cases (81.8%). An unsuccessful treatment outcome was significantly associated with patients aged >44 years (AOR, 3.3, 95% CI = 1.55-6.99).
CONCLUSION AND RECOMMENDATIONS
This study indicated that nearly 23% of MDR/RR-TB patients had unsuccessful treatment outcomes and being older was significantly correlated with these outcomes. For better outcomes, it is recommended to strengthen combined treatment adherence interventions and evaluate treatment regimens and administration options. A prospective cohort study may be required to investigate the full range of potential causes of unfavorable outcomes.
背景
耐多药结核病（MDR-TB）仍然是一场全球公共卫生危机和健康安全威胁。公共卫生基础设施薄弱、感染控制效率低下以及结核病治疗管理不善是耐药结核病（DR-TB）持续出现和传播的原因之一。最终治疗结果是结核病控制项目最直接的衡量标准。因此，本研究旨在确定耐多药/利福平耐药结核病（MDR/RR-TB）治疗患者中结核病治疗结果的比例及预测因素。
方法
在贡德尔大学综合专科医院开展了一项为期10年（2011年至2021年）的基于医院的回顾性队列研究。使用结构化检查表收集了408例MDR-TB患者的记录，其中389例有治疗结果，19例正在接受治疗。
结果
共纳入389例有记录的MDR/RR-TB治疗结果患者。治疗成功率为77.12%，其中58.35%治愈，18.76%完成治疗。死亡率、治疗中断失访率、治疗失败率和未知治疗结果的比例分别为9.25%、6.94%、3.1%和3.6%。就患者类别而言，治疗结果最成功的（83.5%）是诊断为复发病例的患者，其次是新发病例（81.8%）。治疗结果不成功与年龄>44岁的患者显著相关（调整后比值比，3.3，95%置信区间=1.55-6.99）。
结论与建议
本研究表明，近23%的MDR/RR-TB患者治疗结果不成功，且年龄较大与这些结果显著相关。为获得更好的结果，建议加强联合治疗依从性干预措施，并评估治疗方案和给药选择。可能需要开展一项前瞻性队列研究来调查不良结果的所有潜在原因。
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