Kamarul Zaman Mohd Fahmin, Nik Husain Nik Rosmawati, Sidek Mohd Yusof, Abu Bakar Zamzurina
Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.
Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
BMJ Open. 2025 Feb 18;15(2):e093391. doi: 10.1136/bmjopen-2024-093391.
The emergence of drug-resistant tuberculosis (DR-TB) complicates TB management and poses significant challenges to achieve favourable treatment outcomes. Treating DR-TB is more complex and costly, requiring extended treatment durations and consideration of drug toxicity and side effects. This study aims to identify the determinants of unfavourable treatment outcomes among DR-TB patients in Malaysia.
Retrospective case-control study.
Secondary data from the National Tuberculosis Registry (NTBR) across two states in Malaysia.
All reported DR-TB cases in the NTBR between 2016 and 2020 from Selangor and Wilayah Persekutuan Kuala Lumpur, Malaysia. Cases still undergoing treatment at the time of analysis were excluded. A total of 403 cases were analysed, with 181 (44.9%) experiencing unfavourable treatment outcomes and 222 (55.1%) having favourable treatment outcomes. The case group consists of individuals with DR-TB who experienced unfavourable treatment outcomes, while the control group comprises individuals with DR-TB who achieved favourable treatment outcomes.
Unfavourable treatment outcomes, defined as death, treatment failure or loss to follow-up, were assessed. Predictors of these outcomes were identified through multiple logistic regression analysis.
Significant determinants of unfavourable treatment outcomes included being male (adjusted OR (aOR) 2.38, 95% CI 1.44 to 3.94), being single or divorced (aOR 1.61, 95% CI 1.03 to 2.49), having no formal education (aOR 3.09, 95% CI 1.49 to 6.41), people living with HIV (aOR 2.87, 95% CI 1.40 to 5.87) and having DR-TB categorised as rifampicin-resistant tuberculosis (aOR 3.34, 95% CI 1.90 to 5.86) or multidrug-resistant/pre-extensively drug-resistant/extensively drug-resistant-TB (aOR 2.57, 95% CI 1.52 to 4.33).
The findings reveal a high proportion of DR-TB cases with unfavourable treatment outcomes and identify their key determinants. Targeted interventions addressing these factors are essential to improve treatment outcomes.
耐多药结核病（DR-TB）的出现使结核病管理复杂化，并对实现良好的治疗效果构成重大挑战。治疗耐多药结核病更为复杂且成本更高，需要延长治疗时间，并考虑药物毒性和副作用。本研究旨在确定马来西亚耐多药结核病患者治疗效果不佳的决定因素。
回顾性病例对照研究。
来自马来西亚两个州的国家结核病登记处（NTBR）的二手数据。
2016年至2020年间马来西亚雪兰莪州和吉隆坡联邦直辖区NTBR中所有报告的耐多药结核病病例。分析时仍在接受治疗的病例被排除。共分析了403例病例，其中181例（44.9%）治疗效果不佳，222例（55.1%）治疗效果良好。病例组由耐多药结核病且治疗效果不佳的个体组成，而对照组由耐多药结核病且治疗效果良好的个体组成。
评估治疗效果不佳的情况，定义为死亡、治疗失败或失访。通过多因素逻辑回归分析确定这些结果的预测因素。
治疗效果不佳的显著决定因素包括男性（调整后比值比（aOR）2.38，95%置信区间1.44至3.94）、单身或离异（aOR 1.61，95%置信区间1.03至2.49）、未接受过正规教育（aOR 3.09，95%置信区间1.49至6.41）、艾滋病毒感染者（aOR 2.87，95%置信区间1.40至5.87）以及耐多药结核病被分类为利福平耐药结核病（aOR 3.34，95%置信区间1.90至5.86）或耐多药/广泛耐药前/广泛耐药结核病（aOR 2.57，95%置信区间1.52至4.33）。
研究结果显示耐多药结核病病例中治疗效果不佳的比例很高，并确定了其关键决定因素。针对这些因素的有针对性干预对于改善治疗效果至关重要。
