期刊
INFECTION
卷 42, 期 2, 页码 405-413出版社
SPRINGER HEIDELBERG
DOI: 10.1007/s15010-013-0572-2
关键词
Multidrug-resistant tuberculosis; Treatment outcome; South Africa
资金
- South African Tuberculosis AIDS Training (SATBAT) programme (National Institutes of Health/Fogarty International Center) [1U2RTW007370/3]
- Third World Organization for Women in Science (TWOWS)
- University of the Witwatersrand Health Sciences
- European Regional Development Fund
- European Commission (ERDF/FEDER) [A34-05]
- Regional Council of Guadeloupe (Biodiversity project) [CR08/031380]
- Medical Research Council of South Africa
- DST/NRF Centre of Excellence for Biomedical TB Research
- European Social Funds through the Regional Council of Guadeloupe
- Consortium to Respond Effectively to the AIDS/TB Epidemic (CREATE), United States
- Bill and Melinda Gates Foundation
- MRC [MR/K007467/1] Funding Source: UKRI
- Medical Research Council [MR/K007467/1, MR/K012126/1] Funding Source: researchfish
Purpose Multidrug-resistant tuberculosis (MDR-TB) is associated with lengthy treatment, expensive and potentially toxic regimens, and high rates of treatment failure and death. This study describes the outcomes of 351 MDR-TB patients who started treatment between 2004 and 2007 at the provincial MDR-TB referral hospital in Johannesburg, South Africa, and investigates risk factors associated with death. Methods The study involved the assessment of factors associated with treatment outcomes using a retrospective review of patient records, drug-susceptibility data and spoligotyping of isolates. Results Treatment success (completion/cure) was recorded in 158 (48.8 %) patients, while 65 (20 %) died, 93 (28.7 %) defaulted, 8 (2.5 %) failed treatment, 11(3.1 %) were transferred out to other health facilities and 16 (4.6 %) had no recorded final outcome. The proportion of successful treatment increased significantly over time. Univariable and multivariable analysis (P = 0.05) identified the year of MDR-TB diagnosis and spoligotype-defined families as factors associated with treatment outcome. No associations were found between treatment outcome and human immunodeficiency virus (HIV) status, previous TB and additional MDR resistance to streptomycin or ethambutol. Molecular typing of the strains revealed a diverse group of spoligotypes, with Beijing, LAM4 and H3 making up the largest groups. Conclusions This is the first published study to investigate treatment outcomes at this facility and to find a link between genotype and treatment outcome, suggesting that genotype determination could potentially serve as a prognostic factor.
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