Tuberculosis recurrences and predictive factors in a vulnerable population in Catalonia


Autoři: Sílvia Brugueras aff001;  Vinicio-Israel Molina aff004;  Xavier Casas aff004;  Yoel-Domingo González aff004;  Nuria Forcada aff004;  Dora Romero aff004;  Anna Rodés aff005;  Maria-Neus Altet aff004;  José Maldonado aff004;  Mario Martin-Sánchez aff006;  Joan A. Caylà aff007;  Àngels Orcau aff001;  Cristina Rius aff001;  Joan-Pau Millet aff001
Působiště autorů: Epidemiology Service, Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain aff001;  Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain aff002;  Departamento de Pediatría, Obstetricia y Ginecología y Medicina Preventiva, Facultad de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain aff003;  Serveis Clínics, Barcelona, Spain aff004;  Agència de Salut Pública de Catalunya, Barcelona, Spain aff005;  Preventive Medicine and Public Health Training Unit Parc de Salut Mar–Pompeu Fabra University—Public Health Agency of Barcelona (PSMar-UPF-ASPB), Barcelona, Spain aff006;  Foundation of the Tuberculosis Research Unit of Barcelona (fuiTB), Barcelona, Spain aff007
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
doi: 10.1371/journal.pone.0227291

Souhrn

Background

Patients with a history of tuberculosis (TB) have a high probability of recurrence because long-term cure is not always maintained in successfully treated patients. The aim of this study was to identify the probability of TB recurrence and its predictive factors in a cohort of socially vulnerable patients who completed treatment in the TB referral center in Catalonia, which acts as the center for patients with social and health problems.

Methods

This retrospective open cohort study included all patients diagnosed with TB who were admitted and successfully treated in Serveis Clínics between 2000 and 2016 and who remained disease-free for a minimum of 1 year after treatment completion. We calculated the incidence density of TB recurrences per person-years of follow-up. We also estimated the cumulative incidence of TB recurrence at 1, 2, 5, and 10 years of follow-up. Bivariate analysis was conducted using Kaplan-Meier curves. Multivariate analysis was conducted using Cox regression. Hazard ratios (HR) were calculated with their 95% confidence intervals (95%CI).

Results

There were 839 patients and 24 recurrences (2.9%), representing 0.49 per 100 person-years. The probability of a recurrence was 0.63% at 1 year of follow-up, 1.35% at 2 years, and 3.69% at 5 years. The multivariate analysis showed that the predictive factors of recurrence were age older than 34 years (aHR = 3.90; CI = 1.06–14.34 at age 35–45 years and aHR = 3.88; CI = 1.02–14.80 at age >45 years) and resistance to at least one anti-TB drug (aHR = 2.91; CI = 1.11–7.65).

Conclusions

Attention should be paid to socially vulnerable persons older than 34 years with a previous episode of resistant TB. Surveillance resources should be directed toward adequately treated patients who nevertheless have a high risk of recurrence.

Klíčová slova:

Age groups – Extensively drug-resistant tuberculosis – HIV – HIV infections – Medical risk factors – Smoking habits – Spain – Tuberculosis


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