Treatment outcomes and risk factors for an unsuccessful outcome among patients with highly drug-resistant tuberculosis in Ukraine.

Autor:	Pedersen OS; Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark., Butova T; Outpatient Department, Merefa Central District Hospital, Merefa, Ukraine., Kapustnyk V; Kharkiv National Medical University, Kharkiv, Ukraine., Miasoiedov V; Kharkiv National Medical University, Kharkiv, Ukraine., Kuzhko M; Department of Chemoresistant Tuberculosis, National Institute of Phthisiology and Pulmonology named after F. G. Yanovskyi NAMS of Ukraine, Kiev, Ukraine., Hryshchuk L; Department of Internal Medicine Propedeutics and Phthisiology, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine., Kornaha S; Department of Internal Medicine Propedeutics and Phthisiology, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine., Borovok N; Medical Department No. 3, Regional Anti-tuberculosis Dispensary No 1 in Kharkiv, Kharkiv, Ukraine., Raznatovska O; Phthisiology and Pulmonology, Zaporizhzhia State Medical and Pharmaceutical University, Zaporizhzhia, Ukraine., Fedorec A; The Pulmonary Tuberculosis Department No. 2, Zaporizhzhia Regional Phthisiology and Pulmonology Clinical Treatment and Diagnostic Center, Zaporizhzhia, Ukraine., Bogomolov A; Phthisiology, Clinical Immunology and Allergology, National Pirogov Memorial Medical University, Vinnytsya, Ukraine., Tkhorovskiy M; Phthisiology, Clinical Immunology and Allergology, National Pirogov Memorial Medical University, Vinnytsya, Ukraine., Akymenko O; Medical Department No. 3, Regional Anti-tuberculosis Dispensary No 1 in Kharkiv, Kharkiv, Ukraine., Klymenko I; Regional Clinical Dispensary, Kramatorsk, Ukraine., Kulykova O; Outpatient Department, Regional Clinical Tuberculosis Dispensary, Kramatorsk, Ukraine., Karpenko Z; Phthisiatry Center, Chernihiv Regional Hospital, Chernihiv, Ukraine., Shapoval T; Phthisiatry Center, Chernihiv Regional Hospital, Chernihiv, Ukraine., Chursina N; Volyn Regional Phthisiopulmonological Center, Lutsk, Ukraine., Kondratyuk N; Bacteriological Laboratory, Volyn Regional Phthisiopulmonological Center, Lutsk, Ukraine., Parkhomenko O; Mykolaiv Regional Phthisio-pulmonological Medical Center, Mykolaiv, Ukraine., Sazonenko I; Phthisiology, Mykolaiv Regional Phthisiology and Pulmonology Medical Center, Mykolaiv, Ukraine., Ostrovskyy M; Phthisiology and Pulmonology Rate of Occupational Diseases, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine., Makoida I; Phthisiology and Pulmonology Rate of Occupational Diseases, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine., Markovtsiy L; Center of Pulmonary Diseases, Uzhhorod, Ukraine., Skryp V; Center of Pulmonary Diseases, Uzhhorod, Ukraine., Lubenko V; Information and Analytical Department, Phthisiopulmonology Center, Kyiv, Ukraine., Hrankina N; Infectious Diseases and Phthisiology, Krivoy Rig Tuberculosis Dispensary, Dnipro, Ukraine., Bondarenko L; Administration, Sumy Regional Clinical Anti-tuberculosis Dispensary, Sumy, Ukraine., Hlynenko V; Outpatient Department, Sumy Regional Clinical Anti-tuberculosis Dispensary, Sumy, Ukraine., Dahl VN; Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark; Center for Global Health, Aarhus University (GloHAU), Aarhus, Denmark; International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark. Electronic address: victordahl@gmail.com., Butov D; Infectious Diseases and Phthisiology, Kharkiv National Medical University, Kharkiv, Ukraine.
Jazyk:	angličtina
Zdroj:	Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases [Clin Microbiol Infect] 2024 Mar; Vol. 30 (3), pp. 360-367. Date of Electronic Publication: 2023 Dec 06.
DOI:	10.1016/j.cmi.2023.12.001
Abstrakt:	Objectives: To describe demographics, clinical features, and treatment outcomes of patients with highly drug-resistant tuberculosis (TB) in Ukraine, and to evaluate risk factors for an unsuccessful outcome. Methods: Data from patients with multi-, pre-extensively, or extensively drug-resistant TB were collected prospectively from TB dispensaries in 15 out of 24 Ukrainian oblasts (regions) from 2020 to 2021. Treatment outcomes were evaluated using WHO definitions. Risk factors for an unsuccessful outcome were identified using a multivariable logistic regression model. Results: Among 1748 patients, the overall proportion of successful outcomes was 58% (95% confidence interval [95% CI] 56-60) (n = 1015/1748), ranging from 65% (95% CI: 62-69) (n = 531/814) for multidrug-resistant TB to 54% (95% CI: 49-58) (n = 301/563) for pre-extensively drug-resistant TB and 49% (95% CI: 44-55) (n = 183/371) for extensively drug-resistant TB. Results were similar across oblasts, with few exceptions. The strongest risk factors for an unsuccessful outcome were extensively drug-resistant TB (adjusted OR [aOR] 3.23; 95% CI: 1.88-5.53), total serum protein below 62 g/L in adults and below 57 g/L for children and adolescents (aOR 2.79; 95% CI: 1.93-4.04), psychiatric illness (aOR 2.79; 95% CI: 1.46-5.33), age at TB diagnosis >65 years (aOR 2.50; 95% CI: 1.42-4.42), and alcohol misuse (aOR 2.48; 95% CI: 1.89-3.26). Discussion: The overall proportion of successful outcomes among Ukrainians treated for highly drug-resistant TB was 58%, notably better compared with previous years, but still low for extensively drug-resistant TB. Risk factors for unsuccessful outcomes highlight that addressing socioeconomic factors in TB management is crucial. Efforts in maintaining TB dispensaries during and following the ongoing war are highly warranted. (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)
Databáze:	MEDLINE
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