Analysis of the implementation effect and influencing factors of multi-drug resistant tuberculosis management strategy in Guangzhou from 2020 to 2022
Objective To explore the treatment effect and influencing factors of multi-drug resistant tuberculosis(MDR-TB)in Guangzhou.Methods A total of 285 MDR-TB patients with Guangzhou household registration diagnosed and managed according to the MDR-TB management strategy in Guangzhou Chest Hospital from January 2020 to December 2022 were included in the study.Among them,137 patients with treatment outcomes as of March 31,2023 were selected for analysis.There were 97 males and 40 females,aged(48.2±16.2)years,50 cases of initial treatment and 87 cases of retreatment.The demographic and clinical data were collected.The patients were divided into a treatment success group and a poor outcome group based on their treatment outcomes,and the influencing factors of poor outcomes were analyzed by multivariate logistic regression analysis.x2 test,ttest,intention-to-treat analysis,per-protocol analysis,and modified intention-to-treat analysis were used.Results The treatment outcomes included 102 successful cases(74.45％)and 35 cases with poor outcomes(25.55％),including 17 cases of loss to follow-up(12.41％),11 deaths(8.03％),and 7 failures(5.11％).Univariate analysis showed statistically significant differences between the treatment success group and the poor outcome group in terms of ≥65 years old(x2=13.017,P＜0.001),diabetes(x2=5.270,P=0.022),history of irregular treatment(x2=16.555,P＜0.001),resistance to quinolones(x2=9.796,P=0.002),baseline sputum smear positive grade 4+(x2=11.587,P=0.001),and use of bedaquiline or delamanid(x2=6.993,P=0.008).Multivariate logistic regression analysis showed that age ≥65 years old(OR=9.702,95％CI:1.977-47.618,P=0.005),history of irregular treatment(OR=3.221,95％CI:1.234-8.410,P=0.017),and resistance to quinolones(OR=4.925,95％CI:1.808-13.416,P=0.002)were risk factors for poor outcomes in MDR-TB patients.Conclusion MDR-TB management strategy in Guangzhou has achieved good treatment outcomes,which is worth promoting.However,attention should be paid to the impact of risk factors on treatment outcomes.
万方数据
维普
