Abstract:Objective To understand the efficacy of standardized treatment for multidrug-resistant tuberculosis(MDR-TB)and the influencing factors for the treatment outcomes in Lishui. Methods From April 2010 to December 2016,MDR-TB patients who were confirmed and agreed to be treated with standardized regimen in Lishui were observed and recorded. Logistic regression model was used to analyze the influencing factors for the treatment outcomes. Results A total of 68 MDR-TB patients were enrolled in the study,of which 28 cases were cured(41.18%),9 cases completed the treatment course(13.23%),12 cases failed(17.65%),12 cases were interrupted or lost(17.65%)and 7 cases(10.29%)died. Adverse drug reaction was observed in 23 cases and treatment was terminated or changed permanently in 18(78.26%)of these cases. The most common adverse reaction was gastrointestinal reactions. The logistic regression analysis showed that the risk factors for adverse outcome(failure,death and interruption or loss)in MDR-TB patients were lesion without improvement in radiography during treatment(OR=34.930,95%CI:4.669-261.324),positive sputum culture for tuberculosis after 6-month treatment(OR= 15.846,95%CI:2.004-125.321)and termination of treatment due to adverse reaction(OR=10.762,95%CI:1.134- 102.124). Conclusion The treatment success rate of MDR-TB is low and this is associated with no improvement in radiography,no negative sputum culture and too many adverse reactions during treatment.
World Health Organization. Global tuberculosis report 2017[R] . Geneva:WHO,2017.
[3]
BASTOS M L,HUSSAIN H,WEYER K,et al. Treatment outcomes of patients with multidrug-resistant and extensively drug-resistant tuberculosis according to drug susceptibility testing to first-and second-line drugs:an individual patient data meta-analysis[J] . Clin Infect Dis,2014,59(10):1364-1374.
[4]
World Health Organization. WHO treatment guidelines for drug-resistant tuberculosis,2016 update[R] . Geneva:WHO,2016.
[5]
BRODE S K,VARADI R,MCNAMEE J,et al. Multidrug-resistant tuberculosis:Treatment and outcomes of 93 patients[J] .Can Respir J,2015,22(2):97-102.
LIU C H,LI L,CHEN Z,et al. Characteristics and treatment outcomes of patients with MDR and XDR tuberculosis in a TB referral hospital in Beijing:a 13-year experience[J] . PLoS One,2011,6(4):e19399.
[9]
ZHANG Q,WU Z Y,ZHANG Z R,et al. Efficacy and effect of free treatment on multidrug-resistant tuberculosis[J] . Exp Ther Med,2016,11(3):777-782.
[10]
JAIN K,DESAI M,SOLANKI R,et al. Treatment outcome of standardized regimen in patients with multidrug resistant tuberculosis[J] . J Pharmacol Pharmacother,2014,5(2):145-149.
[11]
MARAIS E,MLAMBO C K,LEWIS J J,et al. Treatment outcomes of multidrug-resistant tuberculosis patients in Gauteng,South Africa[J] . Infection,2014,42(2):405-413.
[12]
World Health Organization. Global tuberculosis control report 2011[R] . Geneva:WHO,2011.
[13]
MITNICK C D,FRANKE M F,RICH M L,et al. Aggressive regimens for multidrug-resistant tuberculosis decrease all-cause mortality[J] . PLoS One,2013,8(3):e58664.
[14]
RODRIGUEZ M,MONEDERO I,CAMINERO J A,et al. Successful management of multidrug-resistant tuberculosis under programme conditions in the Dominican Republic[J] . Int J Tuberc Lung Dis,2013,17(4):520-525.
GABORIT B J,REVEST M,ROBLOT F,et al. Characteristics and outcome of multidrug-resistant tuberculosis in a low-incidence area[J] .Med Mal Infect,2018,pii:S0399-077X(17)30946-0.
[17]
CHUNG-DELGADO K,GUILLEN-BRAVO S,REVILLA-MONTAG A,et al. Mortality among MDR-TB cases:comparison with drug-susceptible tuberculosis and associated factors[J] . PLoS One,2015,10(3):e0119332.
KURBATOVA E V,TAYLOR A,GAMMINO V M,et al. Predictors of poor outcomes among patients treated for multidrug-resistant tuberculosis at DOTS-plus projects[J] . Tuberculosis,2012,92(5):397-403.