| Summary: | 碩士 === 國立臺北護理健康大學 === 健康事業管理研究所 === 106 === BACKGROUND: Rifampicin-resistant pulmonary tuberculosis (RR-TB) is an emerging public health threat globally. In 2015, it is estimated that 580000 patients developed RR-TB globally. Among them, about 480000 patients were multidrug-resistant tuberculosis. Genotypic drug-susceptibility tests (DST) were implemented among high risk subjects for drug-resistant tuberculosis in Taiwan since 2007. Sputum culture conversion is an important indicator to evaluate the effectiveness of anti-tuberculosis treatment. However, studies investigating possible interventions to enhance sputum culture conversion among RR-TB were scarce.
OBJECTIVE: The study investigated the impact of implementation of genotypic DST on the efficacy for anti-tuberculosis treatment among patients with RR-TB.
DESIGN: The retrospective cohort study enrolled 104 patients who were treated at Wan Fang hospital during 2007-2016 for RR-TB. Among them, genotypic DST were performed in 32 patients and another 72 patients were diagnosed only with conventional DST. The primary outcome was the two-month sputum culture conversion. The secondary outcome was time to sputum culture conversion. Multivariate logistic regression and Cox regression were performed to determine the independent predictors for sputum culture conversion.
RESULTS: The two-month sputum culture conversion was achieved in 37 (35.6%) of the patients enrolled. Two-month sputum conversion rate was lower in men than that in women [odds ratio (OR) 0.247, 95% confidence interval (95%CI) 0.093-0.657]. Large cavitation on chest x ray were associated with a poorer sputum conversion rate (OR 0.080, 95%CI 0.014-0.499). Higher sputum conversion rate was noted among patients who were diagnosed with genotypic DST (OR 2.993, 95%CI 1.088-8.231). Multivariate Cox regression revealed that men [adjusted hazard ratio (HR) 0.352, 95%CI 0.166-0.741] and large cavitation on chest x ray (HR 0.012, 95%CI 0.024-0.610) were associated with a longer time to culture conversion. Performing genotypic DST was shown to shorten the time to culture conversion (HR 2.334, 95%CI 1.120-4.860).
CONCLUSIONS: Genotypic DST reduces the time to sputum culture conversion among patients with RR-TB. The result of the present study supports the policy of implementing genotypic DST among high risk for drug resistant tuberculosis. To shorten the waiting time for DST result and to avoid transmission of drug-resistant tuberculosis, it is advised to promote the utilisation of genotypic DST in the diagnosis routine for subjects suspected to have RR-TB.
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