The effect of empirical and laboratory-confirmed tuberculosis on treatment outcomes

Abstract The World Health Organization (WHO) criteria for diagnosing and treating Tuberculosis (TB) includes clinical signs, therefore not requiring bacteriological laboratory confirmation. In resource-limited settings, including Kenya, this empirical TB treatment is routine practice however limited...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Osman Abdullahi, Ngari Moses, Deche Sanga, Willetts Annie
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/5bbc281d25cb4535b83efeeb550b8459
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:5bbc281d25cb4535b83efeeb550b8459
record_format	dspace
spelling	oai:doaj.org-article:5bbc281d25cb4535b83efeeb550b84592021-12-02T17:55:04ZThe effect of empirical and laboratory-confirmed tuberculosis on treatment outcomes10.1038/s41598-021-94153-02045-2322https://doaj.org/article/5bbc281d25cb4535b83efeeb550b84592021-07-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-94153-0https://doaj.org/toc/2045-2322Abstract The World Health Organization (WHO) criteria for diagnosing and treating Tuberculosis (TB) includes clinical signs, therefore not requiring bacteriological laboratory confirmation. In resource-limited settings, including Kenya, this empirical TB treatment is routine practice however limited data exist on patient clinical outcomes when comparing the method of diagnosis. We evaluated TB treatment outcomes comparing clinically diagnosed and bacteriologically confirmed TB, 6 months after starting treatment of TB in a rural county in Kenya. Our analysis compared patients with a clinical versus a bacteriologically confirmed TB diagnosis. In this retrospective analysis, we included all adults (≥ 18 years) starting treatment of TB and followed up for 6 months, within the County TB surveillance database from 2012 to 2018. Patients included from both public and private facilities. The TB treatment outcomes assessed included treatment success, treatment failure, death, defaulted and transferred out. We used survival regression models to assess effect of type of diagnosis on TB treatment outcome defining time at risk from date of starting treatment to experiencing one of the treatment outcomes or completing 6-months of treatment. A total of 12,856 patients; median age 37 [IQR 28 − 50] years were included. 7639 (59%) were male while 11,339 (88%) were pulmonary TB cases. Overall, 11,633 (90%) were given first-line TB treatment and 3791 (29%) were HIV infected. 6472 (50%) of the patients were clinically diagnosed of whom 4521/6472 (70%) had a negative sputum/GeneXpert test. During the study 5565 person-years (PYs) observed, treatment success was 82% and 83% amongst clinically and bacteriologically diagnosed patients (P = 0.05). There were no significant differences in defaulting (P = 0.70) or transfer out (P = 0.19) between clinically and bacteriologically diagnosed patients. Mortality was significantly higher among clinically diagnosed patients: 639 (9.9%) deaths compared to 285 (4.5%) amongst the bacteriologically diagnosed patients; aHR 5.16 (95%CI 2.17 − 12.3) P < 0.001. Our study suggests survival during empirical TB treatment is significantly lower compared to patients with laboratory evidence, irrespective of HIV status and age. To improve TB treatment outcomes amongst clinically diagnosed patients, we recommend systematic screening for comorbidities, prompt diagnosis and management of other infections.Osman AbdullahiNgari MosesDeche SangaWilletts AnnieNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-11 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Osman Abdullahi Ngari Moses Deche Sanga Willetts Annie The effect of empirical and laboratory-confirmed tuberculosis on treatment outcomes
description	Abstract The World Health Organization (WHO) criteria for diagnosing and treating Tuberculosis (TB) includes clinical signs, therefore not requiring bacteriological laboratory confirmation. In resource-limited settings, including Kenya, this empirical TB treatment is routine practice however limited data exist on patient clinical outcomes when comparing the method of diagnosis. We evaluated TB treatment outcomes comparing clinically diagnosed and bacteriologically confirmed TB, 6 months after starting treatment of TB in a rural county in Kenya. Our analysis compared patients with a clinical versus a bacteriologically confirmed TB diagnosis. In this retrospective analysis, we included all adults (≥ 18 years) starting treatment of TB and followed up for 6 months, within the County TB surveillance database from 2012 to 2018. Patients included from both public and private facilities. The TB treatment outcomes assessed included treatment success, treatment failure, death, defaulted and transferred out. We used survival regression models to assess effect of type of diagnosis on TB treatment outcome defining time at risk from date of starting treatment to experiencing one of the treatment outcomes or completing 6-months of treatment. A total of 12,856 patients; median age 37 [IQR 28 − 50] years were included. 7639 (59%) were male while 11,339 (88%) were pulmonary TB cases. Overall, 11,633 (90%) were given first-line TB treatment and 3791 (29%) were HIV infected. 6472 (50%) of the patients were clinically diagnosed of whom 4521/6472 (70%) had a negative sputum/GeneXpert test. During the study 5565 person-years (PYs) observed, treatment success was 82% and 83% amongst clinically and bacteriologically diagnosed patients (P = 0.05). There were no significant differences in defaulting (P = 0.70) or transfer out (P = 0.19) between clinically and bacteriologically diagnosed patients. Mortality was significantly higher among clinically diagnosed patients: 639 (9.9%) deaths compared to 285 (4.5%) amongst the bacteriologically diagnosed patients; aHR 5.16 (95%CI 2.17 − 12.3) P < 0.001. Our study suggests survival during empirical TB treatment is significantly lower compared to patients with laboratory evidence, irrespective of HIV status and age. To improve TB treatment outcomes amongst clinically diagnosed patients, we recommend systematic screening for comorbidities, prompt diagnosis and management of other infections.
format	article
author	Osman Abdullahi Ngari Moses Deche Sanga Willetts Annie
author_facet	Osman Abdullahi Ngari Moses Deche Sanga Willetts Annie
author_sort	Osman Abdullahi
title	The effect of empirical and laboratory-confirmed tuberculosis on treatment outcomes
title_short	The effect of empirical and laboratory-confirmed tuberculosis on treatment outcomes
title_full	The effect of empirical and laboratory-confirmed tuberculosis on treatment outcomes
title_fullStr	The effect of empirical and laboratory-confirmed tuberculosis on treatment outcomes
title_full_unstemmed	The effect of empirical and laboratory-confirmed tuberculosis on treatment outcomes
title_sort	effect of empirical and laboratory-confirmed tuberculosis on treatment outcomes
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/5bbc281d25cb4535b83efeeb550b8459
work_keys_str_mv	AT osmanabdullahi theeffectofempiricalandlaboratoryconfirmedtuberculosisontreatmentoutcomes AT ngarimoses theeffectofempiricalandlaboratoryconfirmedtuberculosisontreatmentoutcomes AT dechesanga theeffectofempiricalandlaboratoryconfirmedtuberculosisontreatmentoutcomes AT willettsannie theeffectofempiricalandlaboratoryconfirmedtuberculosisontreatmentoutcomes AT osmanabdullahi effectofempiricalandlaboratoryconfirmedtuberculosisontreatmentoutcomes AT ngarimoses effectofempiricalandlaboratoryconfirmedtuberculosisontreatmentoutcomes AT dechesanga effectofempiricalandlaboratoryconfirmedtuberculosisontreatmentoutcomes AT willettsannie effectofempiricalandlaboratoryconfirmedtuberculosisontreatmentoutcomes
_version_	1718379169704837120

The effect of empirical and laboratory-confirmed tuberculosis on treatment outcomes

Ejemplares similares