Abbew Elizabeth Tabitha, Laryea Roger, Kwakye Ama Owusuaa, Poku Yaw Adusi, Obiri-Yeboah Dorcas, Lynen Lutgarde, Decroo Tom, Rigouts Leen, Lorent Natalie
Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
Department of Internal Medicine, Cape Coast Teaching Hospital, Cape Coast, Ghana.
PLoS Negl Trop Dis. 2025 Jul 2;19(7):e0013204. doi: 10.1371/journal.pntd.0013204. eCollection 2025 Jul.
Multi-drug-resistant and rifampicin-resistant tuberculosis (MDR/RR-TB) pose an urgent health threat in Ghana. Despite ongoing interventions, the outcomes for MDR/RR-TB in Ghana have remained suboptimal over recent years. During this period, there has been an increasing detection of nontuberculous mycobacteria (NTM) in mycobacterial cultures. We sought to examine if the isolation of NTM could be a factor contributing to unfavourable MDR/RR-TB treatment outcomes. We also estimated predictors of NTM isolation, including using the short-course injectable-containing regimen (SCI) versus the all-oral bedaquiline (SCO) regimen and other covariates. This retrospective cohort study analysed MDR/RR-TB patients in Ghana from 2018 to 2021 across four regions. Demographic, clinical, and diagnostic data were collected under the National Tuberculosis Control Program framework. Mycobacterial smears and cultures were used to monitor treatment response, with further identification of NTM using line probe assays and Sanger sequencing. Multivariable logistic regression models evaluated predictors of NTM isolation and having an unfavourable outcome. Of 427 identified MDR/RR-TB patients, 380 were included for analysis: 76.3% were male, the mean age was 43.9 years, and 18.9% were people living with HIV. NTM were isolated in 7.1% of cases, primarily Mycobacterium intracellulare and M. fortuitum, with higher odds of isolation in individuals from the Eastern Region (aOR:14.18, 95% CI: 3.95-50.92). Overall, 67.9% achieved favourable outcomes: 71.4% (185/259) in those on the SCO versus 60.3% (73/121) on the SCI regimen. People living with HIV (aOR 14.18, 95% CI: 3.95-50.92) had an increased odds of having an unfavourable outcome. NTM isolation was not associated with unfavourable outcomes. Our study results suggest that although NTM isolation may occur during the course of MDR/RR-TB treatment, it does not affect MDR/RR-TB treatment outcome. Future research should further explore the implications of NTM co-infection on longer-term MDR/RR-TB outcomes, such as post-TB lung disease, to refine management strategies tailored to the reality of low-resource, high-burden settings.
耐多药和利福平耐药结核病（MDR/RR-TB）在加纳构成了紧迫的健康威胁。尽管一直在进行干预，但近年来加纳MDR/RR-TB的治疗效果仍不尽人意。在此期间，分枝杆菌培养物中检测到非结核分枝杆菌（NTM）的情况越来越多。我们试图研究NTM的分离是否可能是导致MDR/RR-TB治疗效果不佳的一个因素。我们还评估了NTM分离的预测因素，包括使用含短程注射剂的治疗方案（SCI）与全口服的贝达喹啉（SCO）治疗方案以及其他协变量。这项回顾性队列研究分析了2018年至2021年加纳四个地区的MDR/RR-TB患者。在国家结核病控制项目框架下收集了人口统计学、临床和诊断数据。使用分枝杆菌涂片和培养来监测治疗反应，并使用线性探针分析和桑格测序进一步鉴定NTM。多变量逻辑回归模型评估了NTM分离和治疗效果不佳的预测因素。在427名确诊的MDR/RR-TB患者中，380名被纳入分析：76.3%为男性，平均年龄为43.9岁，18.9%为艾滋病毒感染者。7.1%的病例中分离出NTM，主要是胞内分枝杆菌和偶然分枝杆菌，东部地区的个体分离出NTM的几率更高（调整后比值比：14.18，95%置信区间：3.95-50.92）。总体而言，67.9%的患者治疗效果良好：SCO治疗方案组中71.4%（185/259）的患者治疗效果良好，而SCI治疗方案组中这一比例为60.3%（73/121）。艾滋病毒感染者治疗效果不佳的几率增加（调整后比值比14.18，95%置信区间：3.95-50.92）。NTM分离与治疗效果不佳无关。我们的研究结果表明，虽然在MDR/RR-TB治疗过程中可能会分离出NTM，但它不会影响MDR/RR-TB的治疗效果。未来研究应进一步探讨NTM合并感染对MDR/RR-TB长期治疗效果的影响，如结核病后肺部疾病，以完善针对资源匮乏、高负担环境实际情况的管理策略。
