治疗失败结局及其相关危险因素。来自高负担国家巴基斯坦的耐多药结核病患者的前瞻性研究。
Unsuccessful treatment outcome and associated risk factors. A prospective study of DR-TB patients from a high burden country, Pakistan.
机构信息
Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia.
Faculty of Pharmaceutical Sciences, Government College University, Faisalabad, Pakistan.
出版信息
PLoS One. 2023 Aug 10;18(8):e0287966. doi: 10.1371/journal.pone.0287966. eCollection 2023.
INTRODUCTION
Tuberculosis (TB), a curable and preventable infectious disease, becomes difficult to treat if resistance against most effective and tolerable first line anti-TB drugs is developed. The objective of the present study was to evaluate the treatment outcomes and predictors of poor outcomes among drug-resistant tuberculosis (DR-TB) patients treated at a programmatic management unit of drug resistant tuberculosis (PMDT) unit, Punjab, Pakistan.
METHODS
This prospective observational study was conducted at a a PMDT unit in Multan, Punjab, Pakistan. A total of 271 eligible culture positive DR-TB patients enrolled for treatment at the study site between January 2016 and May 2017 were followed till their treatment outcomes were recorded. World Health Organization's (WHO) defined criteria was used for categorizing treatment outcomes. The outcomes of cured and treatment completed were collectively placed as successful outcomes, while death, lost to follow-up (LTFU) and treatment failure were grouped as unsuccessful outcomes. Multivariable binary logistic regression analysis was employed for getting predictors of unsuccessful treatment outcomes. A p-value <0.05 was considered statistically significant.
RESULTS
Of the 271 DR-TB patients analysed, nearly half (51.3%) were males. The patient's (Mean ± SD) age was 36.75 ± 15.69 years. A total of 69% patients achieved successful outcomes with 185 (68.2%) patients being cured and 2 (0.7%) completed therapy. Of the remaining 84 patients with unsuccessful outcomes, 48 (17.7%) died, 2 (0.7%) were declared treatment failure, 34 (12.5%) were loss to follow up. After adjusting for confounders, patients' age > 50 years (OR 2.149 (1.005-4.592) with p-value 0.048 and baseline lung cavitation (OR 7.798 (3.82-15.919) with p-value <0.001 were significantly associated with unsuccessful treatment outcomes.
CONCLUSIONS
The treatment success rate (69%) in the current study participants was below the target set by WHO (>75%). Paying special attention and timely intervention in patients with high risk of unsuccessful treatment outcomes may help in improving treatment outcomes at the study site.
简介
结核病（TB）是一种可治愈和可预防的传染病，如果对最有效和可耐受的一线抗结核药物产生耐药性，治疗将变得更加困难。本研究的目的是评估在巴基斯坦旁遮普省耐药结核病（PMDT）规划管理单位治疗的耐药结核病（DR-TB）患者的治疗结果和不良结局的预测因素。
方法
这是一项在巴基斯坦木尔坦的一个 PMDT 单位进行的前瞻性观察性研究。2016 年 1 月至 2017 年 5 月期间，共有 271 名符合条件的培养阳性 DR-TB 患者在研究点接受治疗，直到记录他们的治疗结果。采用世界卫生组织（WHO）定义的标准对治疗结果进行分类。治愈和治疗完成的结果被归类为成功结果，而死亡、失访（LTFU）和治疗失败被归类为不成功结果。采用多变量二项逻辑回归分析确定不良治疗结果的预测因素。p 值<0.05 被认为具有统计学意义。
结果
在 271 例 DR-TB 患者中，近一半（51.3%）为男性。患者（均值±标准差）年龄为 36.75±15.69 岁。共有 69%的患者获得成功结果，其中 185 例（68.2%）治愈，2 例（0.7%）完成治疗。其余 84 例治疗结果不良的患者中，48 例（17.7%）死亡，2 例（0.7%）治疗失败，34 例（12.5%）失访。在调整混杂因素后，年龄>50 岁的患者（OR 2.149（1.005-4.592），p 值为 0.048）和基线肺空洞（OR 7.798（3.82-15.919），p 值<0.001）与不良治疗结果显著相关。
结论
本研究参与者的治疗成功率（69%）低于世卫组织设定的目标（>75%）。对治疗结局不良风险较高的患者给予特别关注和及时干预，可能有助于改善研究点的治疗结局。
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