Atiqah Asbi, Tong Seng Fah, Nadirah Sulaiman
MD (Moscow), Dr. Fam. Med. (UKM), Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaakob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur, Malaysia.
MBBS (UM), Dr. Fam. Med. (UKM), PhD (University of Sydney) Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaakob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur, Malaysia.
Malays Fam Physician. 2023 Jan 3;18:2. doi: 10.51866/oa.191. eCollection 2023.
Delayed sputum smear conversion in patients with smear-positive pulmonary tuberculosis is a crucial problem at primary care clinics in Sabah resulting in poor treatment outcomes. This study aimed to compare the treatment outcomes between extended and nonextended intensive phase treatments among patients with delayed sputum smear conversion and to identify the factors associated with unsuccessful treatment outcomes.
This retrospective cohort study was conducted using data from a Malaysian tuberculosis registry, medical records and clinic referral emails from five primary care clinics in Kota Kinabalu from January 2014 to December 2018. A total of 163 patients with delayed sputum smear conversion were selected and divided into cohort groups: 90 patients received 3 months of intensive phase treatment (extended intensive phase), and 73 patients received 2 months of intensive phase treatment (non-extended intensive phase).
Of the 163 patients, 33.7% had unsuccessful treatment outcomes (25.2% had treatment failure; 0.6% died; 3.7% defaulted; and 4.3% transferred out), and 3.7% had relapse. There were no significant differences in the prevalence of unsuccessful treatment outcomes (37.6% vs 28.6%, OR=1.51, CI=0.77-2.94, P=0.226) and relapse (2.2% vs 5.7%, 0R=0.36, CI=0.65-2.04, P=0.404) between the extended and non-extended intensive phase groups. High sputum acid-fast bacilli grade (AFB) at 2 months, drug resistance and lack of directly observed treatment, short-course supervision (DOTS) were associated with unsuccessful treatment outcomes.
Extended intensive phase treatment in patients with delayed sputum smear conversion does not prevent unsuccessful treatment outcomes and relapse.
涂片阳性肺结核患者痰涂片转阴延迟是沙巴州基层医疗诊所面临的一个关键问题，导致治疗效果不佳。本研究旨在比较痰涂片转阴延迟患者强化期延长治疗与非延长治疗的治疗效果，并确定与治疗效果不佳相关的因素。
本回顾性队列研究使用了马来西亚结核病登记处的数据、2014年1月至2018年12月哥打基纳巴卢五家基层医疗诊所的病历和诊所转诊电子邮件。共选择了163例痰涂片转阴延迟的患者，并将其分为队列组：90例患者接受3个月的强化期治疗（延长强化期），73例患者接受2个月的强化期治疗（非延长强化期）。
在163例患者中，33.7%的患者治疗效果不佳（25.2%治疗失败；0.6%死亡；3.7%失访；4.3%转出），3.7%的患者复发。延长强化期组与非延长强化期组在治疗效果不佳的患病率（37.6%对28.6%，OR=1.51，CI=0.77-2.94，P=0.226）和复发率（2.2%对5.7%，OR=0.36，CI=0.65-2.04，P=0.404）方面无显著差异。2个月时痰涂片抗酸杆菌（AFB）分级高、耐药以及缺乏直接观察下的短程督导化疗（DOTS）与治疗效果不佳相关。
痰涂片转阴延迟患者的延长强化期治疗并不能预防治疗效果不佳和复发。
