Pulmonary department (C), Abderrahman Mami Hospital, Tunisia.
Tunis El Manar University.
Tunis Med. 2024 Jan 5;102(1):44-48. doi: 10.62438/tunismed.v102i1.4521.
INTRODUCTION-AIM: The emergence of multidrug resistant tuberculosis (MDR-TB) is a threat to global public health. The aim of our study was to determine risk factors for treatment failure in MDR-TB.
Retrospective study conducted between January 2000 and March 2019 including patients with MDR-TB. Characteristics of patients with therapeutic failure were compared to cured ones. Logistic regression analysis was used to identify risk factors for treatment failure.
Our study included 140 patients aged of 42±13 years (18-80). Fifty-seven percent of patients had treatment success and 12% had treatment failure. In multivariate logistic regression analysis, treatment failure was associated with age over 45 years (OR=1.05; 95%CI, 1.024-7.736;p=0.014), primary education level and illiteracy (OR=5.022; 95%CI, 1.316-19.161;p=0,018), history of incarceration (OR=3.291; 95%CI, 1.291-21.083;p=0.016), undernutrition (OR=4.544; 95%CI, 2.304-54.231;p=0,027), extensive TB (OR=6.406; 95%CI, 1.761-23.922; p=0.038), initial high grade positive smears (OR=1.210; 95%CI, 1.187-32.657; p=0.045), positive smear culture at 90 days of treatment (OR=6.871, 95%CI, 3.824-23.541; p=0.003), poor adherence (OR=6.110; 95%CI, 2.740-12.450; p=0.021) and occurrence of psychiatric adverse events (OR=3.644 95%CI, 2.560- 27.268; p=0.041).
Therapeutic education, nutritional and psychological support and close follow-up are strongly recommended to optimize the prognosis of MDR-TB.
简介-目的：耐多药结核病（MDR-TB）的出现对全球公共卫生构成威胁。本研究的目的是确定 MDR-TB 治疗失败的危险因素。
这是一项回顾性研究，于 2000 年 1 月至 2019 年 3 月进行，纳入 MDR-TB 患者。将治疗失败患者的特征与治愈患者进行比较。使用逻辑回归分析确定治疗失败的危险因素。
本研究共纳入 140 例年龄为 42±13 岁（18-80 岁）的患者。57%的患者治疗成功，12%的患者治疗失败。多变量逻辑回归分析显示，年龄>45 岁（OR=1.05；95%CI，1.024-7.736；p=0.014）、小学及以下文化程度和文盲（OR=5.022；95%CI，1.316-19.161；p=0.018）、入狱史（OR=3.291；95%CI，1.291-21.083；p=0.016）、营养不良（OR=4.544；95%CI，2.304-54.231；p=0.027）、广泛结核病（OR=6.406；95%CI，1.761-23.922；p=0.038）、初始高等级阳性涂片（OR=1.210；95%CI，1.187-32.657；p=0.045）、治疗 90 天阳性涂片培养（OR=6.871，95%CI，3.824-23.541；p=0.003）、依从性差（OR=6.110；95%CI，2.740-12.450；p=0.021）和出现精神科不良事件（OR=3.644，95%CI，2.560-27.268；p=0.041）与治疗失败相关。
强烈建议进行治疗教育、营养和心理支持以及密切随访，以优化 MDR-TB 的预后。
