Predictors of poor treatment outcome in multi- and extensively drug-resistant pulmonary TB

Abstract BackgroundDrug-resistant tuberculosis continues to be a public health threat around the globe especially in developing countries. In 2018, the number of new cases of rifampicin-resistant tuberculosis was half a million and about 78% of them had multi-drug resistant tuberculosis. In Ethiopia, the overall proportion of multi-drug resistant tuberculosis was 11.6%. The latest treatment outcome data for people with multi-drug resistant tuberculosis show a global treatment success rate of 56%. Therefore, this study was aimed at assessing multi-drug resistant tuberculosis treatment outcomes and associated factors at St. Peter Specialized Hospital, Ethiopia, 2019. MethodsA retrospective cross-sectional study was done. A total of 384 patient medical charts selected by simple random sampling method were reviewed. The data was collected using a checklist from the patients’ medical charts. The collected data were analyzed with SPSS version 23 computer software package. Summary statistics of a given data for each variable were calculated. A logistic regression model was used to measure the association between the outcome and the predictor variable. Statistical significance was declared at p-value<0.05. Direction and strength of association were expressed using OR and 95% CI. ResultFrom a total of 384 patients, the majority of 245(63.8%) of the study subjects were females. The rate of poor treatment outcome was 173(45.1%). Male patients and patients in the age category of 39-60 years were less likely to have poor treatment outcome compared to female patients and patients in the age category of 18-38 years (AOR = 0.43, 95%CI (0.19, 0.10) and (AOR = 0.28, 95%CI (0.15, 0.52) respectively. Patients with a history of second-line TB drug resistance are more likely to have poor treatment outcomes (AOR = 3.81, 95%CI (1.84, 7.91). Poor treatment outcome was higher among patients with longer treatment duration (AOR = 3.23, 95%CI (1.82, 5.74) compared to patients with short treatment duration. ConclusionThe proportion of poor treatment outcome in patients with multi-drug resistant tuberculosis was high. Therefore, a concerted effort should be done at all levels to improve the treatment outcome of the MDR-TB.

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Time to poor treatment outcome and its predictors among drug-resistant tuberculosis patients on second-line anti-tuberculosis treatment in Amhara region, Ethiopia: retrospective cohort study

BMC Public Health ◽

10.1186/s12889-019-7838-2 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 2

Author(s):

Daniel Bekele Ketema ◽

Kindie Fentahun Muchie ◽

Asrat Atsedeweyn Andargie

Keyword(s):

Body Weight ◽

Treatment Outcome ◽

Survival Time ◽

Drug Resistant ◽

Amhara Region ◽

Drug Resistant Tuberculosis ◽

Tuberculosis Patients ◽

Resistant Tuberculosis ◽

Poor Treatment ◽

Poor Treatment Outcome

Abstract Background Treatment of drug-resistant tuberculosis is often more complex and toxic with longer treatment time and poor treatment outcomes including treatment failure or death. Monitoring drug-resistant tuberculosis therapy including early identification of prognostic factors and close monitoring of body weight in resource-limited settings is crucial to ensure successful treatment. Therefore, this study was conducted to assess time to poor treatment outcome which is defined as the proportion of all patients who died or failed treatment and its predictors among drug-resistant tuberculosis patients on second-line anti-tuberculosis treatment in Amhara region, Ethiopia. Methods A retrospective cohort study was conducted on all patients who started drug-resistant tuberculosis therapy from September 1, 2010 through December 31, 2017, at the University of Gondar Comprehensive Specialized Hospital, Boru-Meda Hospital, and Debre-Markos Referral Hospital in Amhara Region, Ethiopia. Data were entered using Epi-data Version 3.1 and analyzed using R version 3.41 software. The survival time was estimated using Kaplan-Meier survival curve and the survival time between different categorical variables were compared using the log rank test. Event time ratio with 95% confidence interval (CI) and p-value less than 0.05 were used to measure the strength of association and to declare statistically significant predictors respectively. Results A total of 508 patients with a median age of 28.5 [IQR: 22–40] years were included in this study. The overall cumulative survival probability of patients at the end of 24 months was 79% [95% CI,75,84%]. Rate of body weight change [Adjusted time ratio (ATR) = 5; 95% CI: 3.2, 7.7], secondary and above level of education [ATR = 2.3;95% CI:1.2,2.9], being non-anemic [ATR = 2.8,95% CI:1.2,3.8], being non-diabetic [ATR = 3.4;95% CI:1.3,8.8], without clinical complications [ATR = 7.6;95% CI:4.2,13.9], HIV negative [ATR = 1. 94:95% CI:1.35,2.35] and residing in rural [ATR = 0.51,95% CI:0.30,0.86] were predictors of time to poor treatment outcomes. Conclusion The survival rate of tuberculosis patients was higher at end of follow up relative to other studies. However, poor treatment outcome was higher in early phase of therapy. Educational level, rural residence, HIV/AIDS, diabetes mellitus, previous treatment, clinical complication, rate of body weight change and smoking history were significant predictors of time to poor treatment outcome. Therefore, intervention programs should focus on the identified factors to improve survival time of drug-resistant tuberculosis patients.

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Lipid droplets and the transcriptome of Mycobacterium tuberculosis from direct sputa: a literature review

Lipids in Health and Disease ◽

10.1186/s12944-021-01550-5 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Daniel Mekonnen ◽

Awoke Derbie ◽

Adane Mihret ◽

Solomon Abebe Yimer ◽

Tone Tønjum ◽

...

Keyword(s):

Mycobacterium Tuberculosis ◽

Treatment Outcome ◽

Lipid Droplets ◽

Energy State ◽

Pulmonary Tb ◽

Metabolic States ◽

Poor Treatment ◽

Infection Disease ◽

Poor Treatment Outcome ◽

Predicting Treatment Outcome

AbstractMycobacterium tuberculosis (Mtb), the main etiology of tuberculosis (TB), is predominantly an intracellular pathogen that has caused infection, disease and death in humans for centuries. Lipid droplets (LDs) are dynamic intracellular organelles that are found across the evolutionary tree of life. This review is an evaluation of the current state of knowledge regarding Mtb-LD formation and associated Mtb transcriptome directly from sputa.Based on the LD content, Mtb in sputum may be classified into three groups: LD positive, LD negative and LD borderline. However, the clinical and evolutionary importance of each state is not well elaborated. Mounting evidence supports the view that the presence of LD positive Mtb bacilli in sputum is a biomarker of slow growth, low energy state, towards lipid degradation, and drug tolerance. In Mtb, LD may serve as a source of chemical energy, scavenger of toxic compounds, prevent destruction of Mtb through autophagy, delay trafficking of lysosomes towards the phagosome, and contribute to Mtb persistence. It is suggest that LD is a key player in the induction of a spectrum of phenotypic and metabolic states of Mtb in the macrophage, granuloma and extracellular sputum microenvironment. Tuberculosis patients with high proportion of LD positive Mtb in pretreatment sputum was associated with higher rate of poor treatment outcome, indicating that LD may have a clinical application in predicting treatment outcome.The propensity for LD formation among Mtb lineages is largely unknown. The role of LD on Mtb transmission and disease phenotype (pulmonary TB vs extra-pulmonary TB) is not well understood. Thus, further studies are needed to understand the relationships between LD positivity and Mtb lineage, Mtb transmission and clinical types.

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Diabetic Ketoacidosis Management and Treatment Outcome at Medical Ward of Shashemene Referral Hospital, Ethiopia: A Retrospective Study

Clinical Medicine Insights Endocrinology and Diabetes ◽

10.1177/11795514211004957 ◽

2021 ◽

Vol 14 ◽

pp. 117955142110049

Author(s):

Getu Melesie Taye ◽

Amente Jorise Bacha ◽

Fetene Abeje Taye ◽

Mohammed Hussen Bule ◽

Gosaye Mekonen Tefera

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Treatment Outcome ◽

Hospital Mortality ◽

Medical Ward ◽

Inclusion Criteria ◽

Potassium Supplementation ◽

Poor Treatment ◽

Poor Treatment Outcome ◽

Concurrent Medication

Background: Diabetic Ketoacidosis (DKA) is the most common and yet potentially life-threatening acute complication of diabetes that progresses rapidly to death and requires immediate medical intervention. Objective: To assess the DKA management and treatment outcome/in-hospital mortality and its predictors among hospitalized patients with DKA at the Medical ward of Shashemene Referral Hospital (SRH). Method: A retrospective study was conducted at the Medical Ward of SRH from 01 February 2015 to 31 January 2017. A systematic random sampling technique was used to select study subjects based on the inclusion criteria. Thus, of 236 reviewed charts, only 225 patients with DKA fulfilled inclusion criteria. Treatment outcome was considered good for patients who have shown improvement at discharge, while poor for patients who left against medical advice or died in the hospital. Logistic regression analysis was done to determine independent predictors for treatment outcome/in-hospital mortality using SPSS version 20 with statistical significant at P ⩽ .05. Results: Of 225 patients with DKA, 124 (55.1%) were male. Regular insulin was prescribed to all patients and antibiotics were administered to 87 (38.7%). Potassium supplementation was given only for 28 (12.4%). Non-adherence to insulin treatment (n = 91; 40.4%) and infection (n = 66; 29.3%) were the principal DKA precipitating factors. Even though 73.8% of hospitalized patients with DKA have shown good treatment outcomes, DKA contributed 12% in-hospital mortality. The result of multivariate logistic regression analysis shown that hypoglycemia is the only independent predictor for in-hospital mortality[ P = .03]. Moreover, the independent predictors for poor DKA treatment outcome were found to be smoker [ P = .04], Urinary tract infection (UTI) relative to other co-morbid condition [ P < .001], severe hypokalemia which increase risk of poor treatment outcome by around 4 times [ P = .02], and use of Metronidazole as a concurrent medication relative to other concurrent medication [ P = .03]. Conclusion: There was a high in-hospital mortality rate due to correctable causes. This mortality is unacceptable as it was majorly related to the poor practice of potassium supplementation and hypoglycemia due to insulin. Thus, clinicians and stakeholders should have to focus on modifiable factors (hypokalemia, UTI, and hypoglycemia) to reduce poor treatment outcome/in-hospital mortality.

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Prevalence and treatment outcome of extensively drug-resistant tuberculosis plus additional drug resistance from the National Clinical Center for Tuberculosis in China: A five-year review

Journal of Infection ◽

10.1016/j.jinf.2017.08.005 ◽

2017 ◽

Vol 75 (5) ◽

pp. 433-440 ◽

Cited By ~ 10

Author(s):

Yu Pang ◽

Jie Lu ◽

Fengmin Huo ◽

Yifeng Ma ◽

Liping Zhao ◽

...

Keyword(s):

Drug Resistance ◽

Treatment Outcome ◽

Drug Resistant ◽

Drug Resistant Tuberculosis ◽

Resistant Tuberculosis ◽

Extensively Drug Resistant ◽

Clinical Center

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619 ACTIVATED FIBROBLAST GROWTH FACTOR-INDUCIBLE 14 (FN14) PROMOTES INVASION, MIGRATION AND PROLIFERATION OF ANDROGEN INDEPENDENT PROSTATE CANCER CELLS THROUGH MATRIX METALLOPROTEINASE 9 AND CORRELATES WITH POOR TREATMENT OUTCOME

European Urology Supplements ◽

10.1016/s1569-9056(11)60608-8 ◽

2011 ◽

Vol 10 (2) ◽

pp. 201

Author(s):

S. Narita ◽

M. Mingguo ◽

N. Tsuchiya ◽

K. Numakura ◽

T. Obara ◽

...

Keyword(s):

Prostate Cancer ◽

Treatment Outcome ◽

Growth Factor ◽

Matrix Metalloproteinase ◽

Fibroblast Growth ◽

Prostate Cancer Cells ◽

Poor Treatment ◽

Poor Treatment Outcome ◽

Metalloproteinase 9 ◽

Androgen Independent

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Childhood Tuberculosis Treatment Outcome and Its Association with HIV-Co infection in Ethiopia, A Systematic Review and Meta-analysis

10.21203/rs.2.14156/v1 ◽

2019 ◽

Author(s):

Getaneh Mulualem Belay ◽

Chalachew Adugna Wubneh

Keyword(s):

Systematic Review ◽

Treatment Outcome ◽

Successful Treatment ◽

Meta Analysis ◽

Tuberculosis Treatment ◽

World Health ◽

Successful Treatment Outcome ◽

Poor Treatment ◽

Poor Treatment Outcome ◽

Tuberculosis Treatment Outcome

Abstract Introduction Globally around one million children are infected with Tuberculosis. Childhood Tuberculosis is underestimated due diagnosis challenge. HIV infection can affect the TB disease progression and treatment outcome.Objectives The aim of this systematic review and meta-analysis is to determine the pooled estimates of childhood tuberculosis treatment outcome and to analyze the impact of HIV-co infection.Methods We searched all available articles using PubMed, Google scholar and a web of science. Additionally, reference lists of included studies and Ethiopian institutional research repositories were used. Searching was limited to studies conducted in Ethiopia and published in English language. Cohort, cross-sectional and case-control studies were included. A weighted inverse variance random effects- model was used. The overall variations between studies were checked by heterogeneity test Higgins’s method (I 2 ). All included studies were assessed with the JBI quality appraisal criteria. Publication bias was checked with the funnel plot and Egger’s regression test.Result A total of 6 studies with 5,389 participants were included in this systematic review and meta-analysis. The overall pooled estimate of successful treatment outcome was found to be 79.54% (95% CI: 73.00, 86.07). Of which 72.44% were treatment completed. Moreover, this study revealed that the treatment failure, defaulter and death were 0.15%, 5.36%, and 3.54%, respectively. Poor treatment outcome was higher among children with HIV co infection with an odds ratio of 3.15 (95% CI: 1.67, 5.94) as compared to HIV negative children.Conclusion The rate of successful treatment outcome of childhood tuberculosis in Ethiopia found to be low compared to the threshold suggested by the world health organization. HIV co infection is significantly associated with poor treatment outcome. Therefore, special attention better to be given for children infected with HIV.

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