在巴基斯坦,含有贝达喹啉的全口服长效疗法在治疗耐多药/耐利福平结核病方面的疗效。

IF 4.7 3区 医学 Q1 INFECTIOUS DISEASES
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引用次数: 0

摘要

背景:尽管2019年引入了含有贝达喹啉(Bdq)的全口服治疗方案来治疗对利福平耐药/耐多药结核病(MDR/RR-TB)患者,但在MDR-TB负担排名第五的巴基斯坦却缺乏有关其有效性的数据。本研究评估了采用全口服长程治疗方案(LTR)治疗的 MDR/RR-TB 患者的治疗效果,并确定了与治疗效果不佳相关的因素:这项回顾性记录审查包括巴基斯坦九个 PMDT 中心在 2019 年 8 月至 2021 年 2 月期间接受全口服长程治疗方案治疗的所有微生物学确诊肺 MDR/RR-TB 患者。社会人口学和临床数据均来自电子名义记录和报告系统。使用 SPSS 和多变量二元逻辑回归对根据世界卫生组织标准定义的治疗结果进行分析,以确定与不成功结果相关的因素。A p 值 结果:最终分析包括 644 名 MDR/RR-TB 患者(平均年龄为 37.9 ± 17.6 岁),大部分为男性(53.0%),体重不足(68.0%),有结核病治疗史(66.1%),MDR-TB(84.9%),肺空洞(71.0%),无合并症(86.4%)。发现对氟喹诺酮类药物耐药的占 41.9%,使用过二线药物的占 16%,曾接受过 MDR-TB 治疗的占 9.8%。共有 400 例(62.1%)患者被宣布治愈,53 例(8.2%)完成治疗,117 例(18.2%)死亡,37 例(5.7%)失去随访,37 例(5.7%)治疗失败。总体治疗成功率为 70.3%(n = 453)。在多变量分析中,结核病治疗史(OR:1.63, 95 %CI:1.09-2.64, p = 0.023)、既往使用过 SLD(OR:2.09, 95 %CI: 1.20-3.37, p = 0.012)、对 Z 的耐药性(OR:0.43,95 %CI:0.20-0.81,p = 0.023)、耐药 > 5 种药物(OR:3.12,95 %CI:1.36-11.64,p = 0.013)与死亡和治疗失败显著相关。结论:治疗成功率(70.3%)和治疗失败率(70.3%)均与肺空洞(OR:2.66,95 %CI:1.10-7.32,p = 0.045)有关:本研究的治疗成功率(70.3%)低于世界卫生组织推荐的目标成功率(>90%)。加强临床管理,同时特别关注具有已识别风险因素的患者,可以提高治疗效果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Effectiveness of bedaquiline containing all oral longer regimens in treating multidrug/rifampicin resistant tuberculosis in Pakistan

Background

Despite the introduction of bedaquiline (Bdq) containing all-oral regimens for treating patients with rifampicin resistant/multidrug resistant tuberculosis (MDR/RR-TB) in 2019, data on its effectiveness in Pakistan, which has the fifth highest MDR-TB burden, is lacking. This study evaluates treatment outcomes and identifies factors associated with unsuccessful outcomes among MDR/RR-TB patients treated with an all-oral longer treatment regimen (LTR).

Methods

This retrospective record review included all microbiologically confirmed pulmonary MDR/RR-TB patients treated with an all-oral LTR between August 2019 and February 2021 across nine PMDT centres in Pakistan. Sociodemographic and clinical data were retrieved from the Electronic Nominal Recording and Reporting System. Treatment outcomes, defined by WHO criteria, were analysed using SPSS and multivariate binary logistic regression to identify factors associated with unsuccessful outcomes. A p-value < 0.05 was considered statistically significant.

Results

The final analysis included 644 MDR/RR-TB patients (mean age 37.9 ± 17.6 years), mostly male (53.0 %), underweight (68.0 %), with TB treatment history (66.1 %), MDR-TB (84.9 %), lung cavitation (71.0 %), and no comorbidities (86.4 %). Fluoroquinolone resistance was found in 41.9 %, 16 % had used second-line drugs, and 9.8 % had previous MDR-TB treatment. A total of 400 (62.1 %) patients were declared cured, 53 (8.2 %) treatment completed, 117 (18.2 %) died, 37 (5.7 %) lost to follow-up (LTFU), and 37 (5.7 %) treatment failures. Overall treatment success rate was 70.3 % (n = 453). In multivariate analysis, history of TB treatment (OR:1.63, 95 %CI:1.09–2.64, p = 0.023), previous SLD use (OR:2.09, 95 %CI: 1.20–3.37, p = 0.012), resistance to Z (OR:0.43, 95 %CI: 0.20–0.81, p = 0.023), and resistance to > 5 drugs (OR:3.12, 95 %CI:1.36–11.64, p = 0.013) were significantly associated with death and treatment failure. Whereas, lung cavitation had statistically significant association with LTFU (OR:2.66, 95 %CI:1.10–7.32, p = 0.045).

Conclusion

Treatment success rate (70.3 %) in this study fell below the WHO recommended target success rate (>90 %). Enhanced clinical management, coupled with special attention to patients exhibiting identified risk factors could improve treatment outcomes.

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来源期刊
Journal of Infection and Public Health
Journal of Infection and Public Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH -INFECTIOUS DISEASES
CiteScore
13.10
自引率
1.50%
发文量
203
审稿时长
96 days
期刊介绍: The Journal of Infection and Public Health, first official journal of the Saudi Arabian Ministry of National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences and the Saudi Association for Public Health, aims to be the foremost scientific, peer-reviewed journal encompassing infection prevention and control, microbiology, infectious diseases, public health and the application of healthcare epidemiology to the evaluation of health outcomes. The point of view of the journal is that infection and public health are closely intertwined and that advances in one area will have positive consequences on the other. The journal will be useful to all health professionals who are partners in the management of patients with communicable diseases, keeping them up to date. The journal is proud to have an international and diverse editorial board that will assist and facilitate the publication of articles that reflect a global view on infection control and public health, as well as emphasizing our focus on supporting the needs of public health practitioners. It is our aim to improve healthcare by reducing risk of infection and related adverse outcomes by critical review, selection, and dissemination of new and relevant information in the field of infection control, public health and infectious diseases in all healthcare settings and the community.
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