Approval Sheet Risk Factors for Poor Treatment Outcomes among Patients with Multi-Drug Resistant and Extensively Drug-Resistant (M/XDR) Tuberculosis in the Country of Georgia. 公开
Gegia, Medea (2011)
Published
Abstract
Introduction: Resistance of M. tuberculosis to
anti-tuberculosis drugs has become a
major public health problem in many countries, including Georgia.
In 2008, Georgian
National Tuberculosis Program introduced treatment with second line
anti-tuberculosis
drugs, which has allowed for treatment of multidrug or extensively
drug-resistant
tuberculosis (M/XDR)-TB. The study objectives were to assess
treatment outcomes
among the 1st cohort of patients with pulmonary M/XDR-TB and to
determine risk factors
for poor treatment outcomes: defined as death, failure and
default.
Methods: A prospective observational cohort study was
performed. All patients with
M/XDR pulmonary TB who initiated treatment in 2008 were enrolled
and followed until
2010. Descriptive statistics were used to determine associations
between study
covariates. Binary logistic regression
analysis was utilized to determine independent
association of prior treatment history with treatment outcome while
controlling for
potential confounding variables.
Results: 380 patients were included: male (71%); mean age 38
years; median age 38.4
years. 13% had XDR-TB. 1.3% had HIV co-infection. Body Mass Index
(BMI) was <18.5
among 24% of the cohort, and 52% had bilateral lesions on chest
X-ray. Surgery was
performed in 10% (37) of cases. The treatment outcomes were as
follows: 47% had a
poor outcome (death among 59 patients [15%], failure among 37
[10%], and 83 [22%] -
defaulted). In the final multivariable analysis, history of
previous treatment (OR=2.8 95%
CI 1.2 - 6.3) was significantly associated with poor treatment
after controlling for risk
factors. Other independent variables associated with poor treatment
outcomes included
absence of adjunctive surgical therapy (OR 3.7, 95%CI 1.5, 8.7), no
sputum culture
conversion to negative by 4 months (OR 3.0, 95%CI 1.9, 5.0), the
presence of XDR-TB
(OR 2.3, 95% CI 1.2, 2.4), BMI < 18.5 (OR 2.0, 95%CI 1.1, 3.4)
and bilateral lesions on
chest radiograph (OR 1.8, 95%CI 1.2, 2.9).
Conclusions: Overall, 47% of patients with M/XDR-TB had poor
treatment outcome. In
multivariable analysis, independent risk factors for a poor
treatment outcome included
prior TB treatment history, lack of adjunctive surgical
intervention, no culture conversion
by month 4, XDR-TB, low BMI (<18.5) and bilateral lesions on
chest X-ray.
Table of Contents
TABLE OF CONTENTS
INTRODUCTION
............................................................................................................
1
BACKGROUND
.............................................................................................................
3
METHODS......................................................................................................................
6
RESULTS.....................................................................................................................
15
DISCUSION..................................................................................................................
18
CONCLUSION..............................................................................................................
22
REFERENCES
.............................................................................................................
23
TABLES
.......................................................................................................................
25
APPENDIX
...................................................................................................................
29
About this Master's Thesis
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