Rifampicin-resistant tuberculosis in Spain.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
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García-García José-María, Rodrigo-Sanz Teresa, Gullón-Blanco José-Antonio, Casas García Xavier, Millet Joan-Pau, Quirós Fernández Sarai, Martínez Lirola Miguel-José, Mangas Moro Alberto, Domínguez Castellano Ángel, Navas Elorza Enrique, Nieto Marcos Magnolia, Arasa Panisello Francesc, Bermúdez Ruiz Pilar, García Cabrera Manuel, Sanz Herrero Francisco, Suárez Toste Isabel, Urrelo Cerrón Luis Adolfo, Espiau Guarner María, Soriano Arandes Antoni, Arias Guillén Miguel, Cebrián Gallardo José-Joaquín, García-Fuertes Julia-Amaranta, Pérez-Jacoiste Asín María Asunción, Somoza González María, Palacios Gutiérrez Juan-José, Alcaide Fernando, Samper Blasco Sofía, Tabernero Huguet Eva, Caylà Joan A, Ruiz Manzano Juan, Caminero Luna José Antonio, Working Group on Rifampicin Resistant Tuberculosis of the Tuberculosis Research Programme (PII-TB) SEPAR
Аннотация
METHODS: This was an ambispective observational study of a multicentre cohort of patients diagnosed between January 2019 and July 2023 in most Autonomous Communities (retrospective period 2019-2020, prospective 2021-2023).
RESULTS: 94 patients were included; 83 (88.3%) had pulmonary tuberculosis. The mean age was 38.00±17.8 years; 67 (71.3%) were male, 62 (66.0%) were from countries other than Spain, six (6.4%) were HIV-infected and 24 (25.5%) had previously treated tuberculosis. Nine patients had rifampicin-resistant tuberculosis (RR-TB), 75 multidrug-resistant tuberculosis (MDR-TB), nine pre-extensively drug-resistant tuberculosis (pre-XDR-TB) and one XDR-TB. Treatment included bedaquiline in 39 (41.5%) patients, linezolid in 87 (92.6%), fluoroquinolones in 82 (87.2%), clofazimine in 64 (68.0%) and delamanid in 27 (28.7%). Treatment was supervised by experts in 63 cases (67.0%). In 43 patients (45.7%), there were difficulties obtaining authorisation for drug prescription (bedaquiline or delamanid). 21 patients (22.3%) had difficulties understanding the treatment. The final treatment outcomes were cured in 60 cases (63.8%), treatment completed in 23 (24.5%), deaths in 3 (3.2%), with 2 due to tuberculosis, loss to follow-up in five (5.3%) and not evaluated in three (3.2%). No treatment failures occurred. Successful outcomes were achieved in 83 patients (88.3%). MDR-TB compared with pre-XDR-TB (OR 8.77, 95% CI 1.42-45.55; p=0.01) and no treatment comprehension difficulties (OR 10.61, 95% CI 2.78-40.48; p=0.001) were both associated with successful outcomes.
CONCLUSIONS: Most patients achieved successful outcomes with individualised regimens guided predominantly by experts. Patients with pre-XDR-TB and those with comprehension difficulties had significantly reduced success rates.