埃塞俄比亚标准化注射短程方案治疗耐多药结核病的治疗结局：一项回顾性队列研究。

Treatment outcomes of standardized injectable shorter regimen for multi-drugs resistant tuberculosis in Ethiopia: a retrospective cohort study.

机构信息

Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia.

Department of Social and Administrative Pharmacy, Wollo University, Dessie, Ethiopia.

出版信息

BMC Infect Dis. 2024 Aug 17;24(1):837. doi: 10.1186/s12879-024-09745-8.

DOI:10.1186/s12879-024-09745-8

PMID:39152383

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11329998/

Abstract

BACKGROUND

The injectable shorter multi-drug resistant tuberculosis (MDR-TB) regimen, has been reported to be less costly and more effective in the treatment of MDR-TB compared to the longer regimen. Ethiopia introduced the injectable shorter regimen (SR) in April 2018 following official recommendation by the World Health Organization (WHO) in 2016. While the WHO recommendation was based on evidence coming from extensive programmatic studies in some Asian and African countries, there is paucity of information on patient outcomes in the Ethiopian context. Thus, we aimed to assess the treatment outcomes and identify factors associated with the outcomes of MDR-TB patients on injectable SR.

METHODS

A multi-center facility-based retrospective cohort study was conducted in Ethiopia on 245 MDR-TB patients who were treated between April 2018 and March 2020. Data were collected from patients' medical records and analyzed using SPSS version 25. Descriptive statistics was used to summarize the results while inferential analysis was employed to investigate predictors of treatment outcomes and survival status.

RESULTS

A total of 245 patients were included in the study, with 129 (52.7%) of them being female. Median age of the patients was 27 (IQR: 21-33). The overall treatment success rate was 87.8%, with 156 (63.7%) cured and 59 (24.1%) patients who completed treatment. The unfavorable outcomes accounted for 12.2%, with 16 (6.5%) treatment failure, 8 (3.3%) death and 6 (2.4%) lost to follow up. Majority of the unfavorable outcomes occurred during the early phase of therapy, with median time to event of 1.8 months (95% CI: 0.99-2.69). The use of khat (a green leafy shrub abused for its stimulant like effect) and being diagnosed with MDR-TB than rifampicin resistant only, were identified as independent factors associated with unfavorable outcomes.

CONCLUSION

The injectable SR for MDR-TB was found to have positive treatment outcomes in the context of programmatic management in Ethiopia.

摘要

背景

与较长疗程相比，注射用较短的耐多药结核病（MDR-TB）方案在治疗 MDR-TB 方面成本更低，效果更好。埃塞俄比亚在 2016 年世界卫生组织（WHO）正式建议后，于 2018 年 4 月引入了注射用较短方案（SR）。虽然世卫组织的建议是基于一些亚洲和非洲国家广泛的方案研究得出的证据，但在埃塞俄比亚的情况下，关于患者结果的信息很少。因此，我们旨在评估 MDR-TB 患者接受注射用 SR 治疗的结果，并确定与结果相关的因素。

方法

在埃塞俄比亚进行了一项多中心基于机构的回顾性队列研究，纳入了 245 名于 2018 年 4 月至 2020 年 3 月期间接受治疗的 MDR-TB 患者。数据从患者的病历中收集，并使用 SPSS 版本 25 进行分析。使用描述性统计来总结结果，同时使用推断分析来调查治疗结果和生存状况的预测因素。

结果

共纳入 245 名患者，其中 129 名（52.7%）为女性。患者的中位年龄为 27 岁（IQR：21-33）。总的治疗成功率为 87.8%，156 名（63.7%）治愈，59 名（24.1%）患者完成治疗。不良结局占 12.2%，16 名（6.5%）治疗失败，8 名（3.3%）死亡，6 名（2.4%）失访。大多数不良结局发生在治疗的早期阶段，事件中位时间为 1.8 个月（95%CI：0.99-2.69）。使用阿拉伯茶（一种因其兴奋剂作用而被滥用的绿色叶状灌木）和诊断为 MDR-TB 而不是利福平耐药，被确定为与不良结局相关的独立因素。