Treatment interruptions in patients with MDR/XDR-TB: risk factors and impact on treatment outcomes

Malnutrition in hospitalised patients has a significant and disadvantageous impact on treatment outcome. If possible, enteral nutrition with an energy/protein-balanced nutrient should be preferred depending on the patient’s condition, type of illness and risk factors. The aim of the nutrition therapy is to increase the efficacy of treatment and shorten the length of hospital stay in order to ensure rapid rehabilitation. In the present review the authors summarize the most important clinical and practical aspects of enteral nutrition therapy. Orv. Hetil., 2014, 155(51), 2028–2033.

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Risk Factors for Unfavorable Treatment Outcomes among the Human Immunodeficiency Virus-Associated Tuberculosis Population in Tashkent City, Uzbekistan: 2013–2017

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18094623 ◽

2021 ◽

Vol 18 (9) ◽

pp. 4623

Author(s):

Sherali Massavirov ◽

Kristina Akopyan ◽

Fazlkhan Abdugapparov ◽

Ana Ciobanu ◽

Arax Hovhanessyan ◽

...

Keyword(s):

Risk Factors ◽

Human Immunodeficiency Virus ◽

Treatment Outcomes ◽

Sputum Smear ◽

People Living With Hiv ◽

Tb Treatment ◽

Cell Counts ◽

Cd4 Cell Counts ◽

Immunodeficiency Virus ◽

Positive Sputum Smear

Tuberculosis (TB) and human immunodeficiency virus (HIV) co-infection poses a growing clinical challenge. People living with HIV have a higher chance of developing TB, and once the disease has progressed, are at greater risk of having unfavorable TB treatment outcomes. Data on TB treatment outcomes among the HIV-associated TB population in Uzbekistan are limited. Thus, we conducted a cohort study among 808 adult patients with HIV-associated TB registered at the Tashkent TB referral hospital from 2013–2017 to document baseline characteristics and evaluate risk factors for unfavorable TB treatment outcomes. The data were collected from medical records and ambulatory cards. About 79.8% of the study population had favorable treatment outcomes. Antiretroviral therapy (ART) coverage at the admission was 26.9%. Information on CD4-cell counts and viral loads were largely missing. Having extrapulmonary TB (aOR 2.21, 95% CI: 1.38–3.53, p = 0.001), positive sputum smear laboratory results on admission (aOR 1.62, 95% CI: 1.07–2.40), diabetes (aOR 5.16, 95% CI: 1.77–14.98), and hepatitis C (aOR 1.68, 95% CI: 1.14–2.46) were independent risk factors for developing unfavorable TB treatment outcomes. The study findings provide evidence for targeted clinical management in co-infected patients with risk factors. Strengthening the integration of TB/HIV services may improve availability of key data to improve co-infection management.

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An Innovative National Programme for Comprehensive Chronic Wound Therapy and Its Impact on Treatment Outcomes

World Journal of Surgery ◽

10.1007/s00268-020-05901-8 ◽

2021 ◽

Author(s):

Kryspin Mitura

Keyword(s):

Treatment Outcomes ◽

Chronic Wound ◽

Wound Therapy ◽

National Programme ◽

Impact On Treatment

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Trends, Characteristics and Treatment Outcomes of Patients with Drug-Resistant Tuberculosis in Uzbekistan: 2013–2018

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18094663 ◽

2021 ◽

Vol 18 (9) ◽

pp. 4663

Author(s):

Khasan Safaev ◽

Nargiza Parpieva ◽

Irina Liverko ◽

Sharofiddin Yuldashev ◽

Kostyantyn Dumchev ◽

...

Keyword(s):

Risk Factors ◽

Treatment Outcomes ◽

Treatment Success ◽

National Level ◽

Drug Resistant ◽

Drug Resistant Tuberculosis ◽

Loss To Follow Up ◽

Resistant Tuberculosis ◽

Mdr Tb

Uzbekistan has a high burden of drug-resistant tuberculosis (TB). Although conventional treatment for multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) has been available since 2013, there has been no systematic documentation about its use and effectiveness. We therefore documented at national level the trends, characteristics, and outcomes of patients with drug-resistant TB enrolled for treatment from 2013–2018 and assessed risk factors for unfavorable treatment outcomes (death, failure, loss to follow-up, treatment continuation, change to XDR-TB regimen) in patients treated in Tashkent city from 2016–2017. This was a cohort study using secondary aggregate and individual patient data. Between 2013 and 2018, MDR-TB numbers were stable between 2347 and 2653 per annum, while XDR-TB numbers increased from 33 to 433 per annum. At national level, treatment success (cured and treatment completed) for MDR-TB decreased annually from 63% to 57%, while treatment success for XDR-TB increased annually from 24% to 57%. On multivariable analysis, risk factors for unfavorable outcomes, death, and loss to follow-up in drug-resistant TB patients treated in Tashkent city included XDR-TB, male sex, increasing age, previous TB treatment, alcohol abuse, and associated comorbidities (cardiovascular and liver disease, diabetes, and HIV/AIDS). Reasons for these findings and programmatic implications are discussed.

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Outcomes and Risk Factors in Prosthetic Joint Infections by multidrug-resistant Gram-negative Bacteria: A Retrospective Cohort Study

Antibiotics ◽

10.3390/antibiotics10030340 ◽

2021 ◽

Vol 10 (3) ◽

pp. 340

Author(s):

Raquel Bandeira da Silva ◽

Mauro José Salles

Keyword(s):

Risk Factors ◽

Treatment Failure ◽

Treatment Outcomes ◽

Revision Arthroplasty ◽

Multidrug Resistant ◽

Gram Negative Bacteria ◽

Gram Negative ◽

Postoperative Hematoma ◽

Prosthetic Joint ◽

Prosthetic Joint Infections

Gram-negative bacteria (GNB), including multidrug-resistant (MDR) pathogens, are gaining importance in the aetiology of prosthetic joint infection (PJI). This retrospective observational study identified independent risk factors (RFs) associated with MDR-GNB PJI and their influence on treatment outcomes. We assessed MDR bacteria causing hip and knee PJIs diagnosed at a Brazilian tertiary hospital from January 2014 to July 2018. RFs associated with MDR-GNB PJI were estimated by bivariate and multivariate analyses using prevalence ratios (PRs) with significance at p < 0.05. Kaplan–Meier analysis was performed to evaluate treatment outcomes. Overall, 98 PJI patients were analysed, including 56 with MDR-GNB and 42 with other bacteria. Independent RFs associated with MDR-GNB PJI were revision arthroplasty (p = 0.002), postoperative hematoma (p < 0.001), previous orthopaedic infection (p = 0.002) and early infection (p = 0.001). Extensively drug-resistant GNB (p = 0.044) and comorbidities (p = 0.044) were independently associated with MDR-GNB PJI treatment failure. In sum, MDR-GNB PJI was independently associated with previous orthopaedic surgery, postoperative local complications and pre-existing infections and was possibly related to selective pressure on bacterial skin colonisation by antibiotics prescribed for early PJI. Infections due to MDR-GNB and comorbidities were associated with higher treatment failure rates.

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Prevalence of Smoking and Its Impact on Treatment Outcomes in Newly Diagnosed Pulmonary Tuberculosis Patients: A Hospital-Based Prospective Study

Chonnam Medical Journal ◽

10.4068/cmj.2015.51.2.86 ◽

2015 ◽

Vol 51 (2) ◽

pp. 86 ◽

Cited By ~ 22

Author(s):

Vinay Mahishale ◽

Bhagyashri Patil ◽

Mitchelle Lolly ◽

Ajith Eti ◽

Sujeer Khan

Keyword(s):

Pulmonary Tuberculosis ◽

Prospective Study ◽

Treatment Outcomes ◽

Newly Diagnosed ◽

Tuberculosis Patients ◽

Impact On Treatment

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Impact of Extended-Spectrum β-Lactamase Production on Treatment Outcomes of Acute Pyelonephritis Caused by Escherichia coli in Patients without Health Care-Associated Risk Factors

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.04821-14 ◽

2015 ◽

Vol 59 (4) ◽

pp. 1962-1968 ◽

Cited By ~ 13

Author(s):

Sun Hee Park ◽

Su-Mi Choi ◽

Dong-Gun Lee ◽

Sung-Yeon Cho ◽

Hyo-Jin Lee ◽

...

Keyword(s):

Risk Factors ◽

Escherichia Coli ◽

Health Care ◽

Treatment Outcomes ◽

Acute Pyelonephritis ◽

Esbl Production ◽

Content Type ◽

E Coli ◽

Extended Spectrum ◽

The Impact

ABSTRACTExtended-spectrum β-lactamase-producingEscherichia coli(ESBL-EC) is increasingly identified as a cause of acute pyelonephritis (APN) among patients without recent health care contact, i.e., community-associated APN. This case-control study compared 75 cases of community-associated ESBL-EC APN (CA-ESBL) to 225 controls of community-associated non-ESBL-EC APN (CA-non-ESBL) to identify the risk factors for ESBL-EC acquisition and investigate the impact of ESBL on the treatment outcomes of community-associated APN (CA-APN) caused byE. coliat a Korean hospital during 2007 to 2013. The baseline characteristics were similar between the cases and controls; the risk factors for ESBL-EC were age (>55 years), antibiotic use within the previous year, and diabetes with recurrent APN. The severity of illness did not differ between CA-ESBL and CA-non-ESBL (Acute Physiology and Chronic Health Evaluation [APACHE] II scores [mean ± standard deviation], 7.7 ± 5.9 versus 6.4 ± 5.3;P= 0.071). The proportions of clinical (odds ratio [OR], 1.76; 95% confidence interval [CI], 0.57 to 5.38;P= 0.323) and microbiological (OR, 1.16; 95% CI, 0.51 to 2.65;P= 0.730) cures were similar, although the CA-ESBL APN patients were less likely to receive appropriate antibiotics within 48 h. A multivariable Cox proportional hazards analysis of the prognostic factors for CA-APN caused byE. colishowed that ESBL production was not a significant factor for clinical (hazard ratio [HR], 0.39; 95% CI, 0.12 to 1.30;P= 0.126) or microbiological (HR, 0.49; 95% CI, 0.21 to 1.12;P= 0.091) failure. The estimates did not change after incorporating weights calculated using propensity scores for acquiring ESBL-EC. Therefore, ESBL production did not negatively affect treatment outcomes among patients with community-associatedE. coliAPN.

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