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Ghorai RP, Jain S, Nayak B, Singh P, Nayyar R, Kumar R, Seth A. Long-term Outcomes of Augmentation Cystoplasty in Genitourinary Tuberculosis in Adults: A 12-year Follow-up Experience at a Tertiary Care Center. Urology 2024:S0090-4295(24)00303-0. [PMID: 38663585 DOI: 10.1016/j.urology.2024.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 04/16/2024] [Accepted: 04/18/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVE To evaluate the long-term effectiveness and consequences of augmentation cystoplasty in adult patients with small capacity bladder due to genitourinary tuberculosis (GUTB). METHODS After approval of the institutional ethical committee, we retrospectively analyzed the database of adult patients with small capacity bladder due to GUTB treated by augmentation cystoplasty from January 2010 to December 2022 at our center. The patients were followed up at 6 weeks postoperatively, then every 3 months for first year and 6 months in second year, and then annually. Patients were assessed for symptoms, renal function, blood biochemistry levels, and ultrasound KUB at each follow-up visit. RESULTS A total of 40 patients underwent augmentation cystoplasty were included. All patients underwent augmentation cystoplasty either with ileum (n = 35) or sigmoid colon (n = 5). On long-term follow-up, there was statistically significant improvement in bladder capacity, decrease in voiding frequency (P = .00), decrease in eGFR (P = .02) and increase in serum creatinine (P = .02). Significant complications were wound infection 4 (10%), intestinal obstruction 1(2.5%), urinary tract infection 6 (15%), bladder stone 2 (5%), mucus retention 3 (7.5%), hypocalcemia with metabolic acidosis 2 (5%) and need of intermittent catheterization in 11 (27.5%) patients. CONCLUSION Multidrug therapy with judicious reconstructive surgery is the optimal treatment modality for GUTB with cicatrization sequelae. In GUTB, augmentation cystoplasty is a safe procedure and strict long-term follow-up is needed to prevent complications.
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Affiliation(s)
| | - Siddharth Jain
- Department of Urology, AIIMS New Delhi, New Delhi, India
| | | | - Prashant Singh
- Department of Urology, AIIMS New Delhi, New Delhi, India
| | - Rishi Nayyar
- Department of Urology, AIIMS New Delhi, New Delhi, India
| | - Rajeev Kumar
- Department of Urology, AIIMS New Delhi, New Delhi, India
| | - Amlesh Seth
- Department of Urology, AIIMS New Delhi, New Delhi, India
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Pedersen OS, Holmgaard FB, Mikkelsen MKD, Lange C, Sotgiu G, Lillebaek T, Andersen AB, Wejse CM, Dahl VN. Global treatment outcomes of extensively drug-resistant tuberculosis in adults: A systematic review and meta-analysis. J Infect 2023; 87:177-189. [PMID: 37356629 DOI: 10.1016/j.jinf.2023.06.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 06/21/2023] [Indexed: 06/27/2023]
Abstract
INTRODUCTION Historically, extensively drug-resistant tuberculosis has been notoriously difficult to treat with devasting outcomes. As we are coming to the end of an era where the 2006 extensively drug-resistant tuberculosis definitions and old treatment regimens are being replaced, we aimed to estimate the proportion of extensively drug-resistant tuberculosis patients globally who achieved successful treatment outcomes. METHODS We conducted a systematic review of PubMed/MEDLINE, Scopus, Web of Science, and Embase from January 1, 2005, through April 3, 2023. Included studies reported WHO treatment outcomes, or adaptions hereof, for pre-extensively and/or extensively drug-resistant tuberculosis patients according to the 2006 WHO definition. Eligible studies included cohorts of at least 10 adults (aged>18 years) that were not pregnant. Using a random-effects model, we calculated pooled proportions of treatment outcomes and performed sensitivity and subgroup analyses. PROSPERO registration number: CRD42022340961. RESULTS Among 5056 studies reviewed, we identified 94 studies from 26 countries, involving 10,223 extensively drug-resistant tuberculosis patients. The pooled proportion of successful treatment outcomes was 44.2% (95%CI: 38.3-50.3). Sensitivity analyses consistently produced similar estimates. A slight improvement in treatment outcomes was observed after 2013. Furthermore, 25 studies reported outcomes for 3564 individuals with pre-extensively drug-resistant tuberculosis, of which 63.3% achieved successful treatment (95%CI: 43.1-72.5). CONCLUSION Globally, the success rate of extensively drug-resistant tuberculosis treatment is 44.2%, far below the WHO's target rate of 75%. These results may serve as a reference for future studies assessing extensively drug-resistant tuberculosis treatment outcomes under the 2021 definition treated with better treatment regimens available. Comprehensive surveillance data of extensively drug-resistant tuberculosis outcomes from the whole world are desirable to monitor treatment progress.
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Affiliation(s)
- Ole Skouvig Pedersen
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Christoph Lange
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany; German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Borstel, Germany; Respiratory Medicine and International Health, University of Lübeck, Lübeck, Germany; Baylor College of Medicine and Texas Children´s Hospital, Global TB Program, Houston, TX, USA
| | - Giovanni Sotgiu
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Troels Lillebaek
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark
| | | | - Christian Morberg Wejse
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark; Center for Global Health, Aarhus University (GloHAU), Aarhus, Denmark
| | - Victor Naestholt Dahl
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark; International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark; Center for Global Health, Aarhus University (GloHAU), Aarhus, Denmark.
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Riccardi N, Antonello RM, Ferrarese M, Saderi L, Besozzi G, Sotgiu G, Codecasa L. Tuberculosis in migrants: epidemiology, resistance and outcome in Milan, Italy. Infect Dis (Lond) 2023; 55:543-550. [PMID: 37255343 DOI: 10.1080/23744235.2023.2217912] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 05/21/2023] [Accepted: 05/22/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Human migration and the ever-changing geopolitical scenarios are redefining the epidemiology and the management of tuberculosis (TB), especially in low-TB burden countries welcoming high rates of people from high-TB burden countries. METHODS We conducted an observational retrospective mono-centric study in a Northern-Italy TB reference centre from 1 January 1990 to 31 December 2019, focusing on the differences in epidemiology, resistance patterns and treatment outcomes between Italians and migrants with active TB. Data were collected from medical records. RESULTS A total of 10555 patients were included, 4614 Italians and 5941 migrants. Among migrants, higher rates of rifampin-resistant (RR) or multidrug-resistant (MDR) TB were reported, as well as higher rates of loss to follow-up. Among Italians, higher mortality rates and a higher number of extrapulmonary TB cases were found. CONCLUSION Our study describes one of the largest cohorts of patients with active TB in Italy, highlighting the need for tailored approaches in native and migrant populations.
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Affiliation(s)
- Niccolò Riccardi
- StopTB Italia Onlus, Milan, Italy
- Department of Clinical and Experimental Medicine, Infectious Disease Unit, University of Pisa, Pisa, Italy
| | | | - Maurizio Ferrarese
- StopTB Italia Onlus, Milan, Italy
- Regional TB Reference Centre, Villa Marelli Institute, Niguarda Hospital, Milan, Italy
| | - Laura Saderi
- StopTB Italia Onlus, Milan, Italy
- Department of Medical, Surgical and Experimental Sciences, Clinical Epidemiology and Medical Statistics Unit, University of Sassari, Sassari, Italy
| | | | - Giovanni Sotgiu
- StopTB Italia Onlus, Milan, Italy
- Department of Medical, Surgical and Experimental Sciences, Clinical Epidemiology and Medical Statistics Unit, University of Sassari, Sassari, Italy
| | - Luigi Codecasa
- StopTB Italia Onlus, Milan, Italy
- Regional TB Reference Centre, Villa Marelli Institute, Niguarda Hospital, Milan, Italy
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Abstract
Antimicrobial Resistance (AMR) has become a global threat to public health systems around the world in recent decades. In 2017, Italy was placed among the worst-performing nations in Europe by the European Centre for Disease Prevention and Control, due to worryingly high levels of AMR in Italian hospitals and regions. The aim of this systematic review was to investigate the state of the art of research on AMR in Italy over the last five years. The PubMed database was searched to identify studies presenting original data. Forty-three of the 9721 records identified were included. Overall, AMR rates ranged from 3% (in a group of sheep farmers) to 78% (in a hospital setting). The methods used to identify the microorganisms, to test their susceptibility and the criteria adopted for the breakpoint were deficient in 7, 7 and 11 studies, respectively. The main findings of our review were that most studies (79.1%) considered hospitalised patients only, 4 studies (9.3%) analysed non-hospitalised populations only. In addition, only 7 studies were multicentric and no scientific literature on the subject was produced in 7 Italian regions. In order to have a solid basis on the topic for the interventions of public health professionals and other stakeholders, studies analysing the phenomenon should be conducted in a methodologically standardised manner, should include all areas of the country and should also focus on out-of-hospital and community-based care and work settings.
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Predictors for Pulmonary Tuberculosis Outcome and Adverse Events in an Italian Referral Hospital: A Nine-Year Retrospective Study (2013–2021). Ann Glob Health 2022; 88:26. [PMID: 35582409 PMCID: PMC9053535 DOI: 10.5334/aogh.3677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: The COVID-19 pandemic has undone years of progress in providing essential TB services and controlling the TB burden. Italy, a low TB burden country, has an incidence of 7.1 cases per 100,000 people. To control the TB spreading in Italy is critical to investigate the characteristics of patients with the worst outcomes and the highest risk of adverse events related to antituberculosis therapy. Therefore, we conducted a large retrospective study in TB patients admitted to the Clinic of Infectious Diseases University of Bari, Italy, in order to describe the clinical presentation and the factors associated with adverse events and outcomes. Methods: We retrospectively evaluated the patients admitted to the Clinic of Infectious Diseases from January 2013 to 15 December 2021. We stratified our cohort into two groups: <65 years of age and ≥65 years in order to assess any differences between the two groups. Two logistic regression models were implemented considering the dependent variables as: (I) the adverse events; and (II) the unsuccessful treatments. Results: In total, 206 consecutive patients [60% (n = 124) M, median age 39 years, range 16–92] were diagnosed and admitted with TB at Clinic of Infectious Diseases. Of the whole sample, 151 (74%) were <65 years and 55 (26%) were ≥65. Statistically significant differences between the two groups were detected (p-value < 0.05) for nationality (p-value = 0.01), previous contact with TB patient (p-value = 0.00), type of TB (p-value = 0.00), unsuccessful treatment (p-value = 0.00), length of hospitalization (p-value = 0.02) and diagnostic delay (p-value = 0.01). Adverse events related to TB drug regimen were reported in 24% (n = 49). Age < 65 years (O.R. = 3.91; 95% CI 1.72–4.21), non-Italian nationality (O.R. = 4.45; 95% CI 2.22–4.98.), homeless (O.R. = 3.23; 95% CI 2.58–4.54), presence of respiratory symptoms (O.R. = 1.23; 95% CI 1.10–1.90), diagnostic delay (O.R = 2.55; 95% CI 1.98–3.77) resulted associated with unsuccessful treatment outcome (death, failure or lost to follow up). Finally, age < 65 years (O.R. = 1.73; 95% CI 1.31–2.49), presence of pulmonary TB (O.R. = 1.15; 95% CI 1.02–1.35), length of hospitalization (O.R. = 1.82; 95% CI 1.35–2.57) and TB culture positive (O.R. = 1.35; 95% CI 1.12–1.82) were associated with adverse events in our populations. Conclusions: The pharmacological approach alone seems insufficient to treat and cure a disease whose ethiopathogenesis is not only due to the Mycobacterium tuberculosis, but also to the poverty or the social fragility. Our data suggest that young foreigners, the homeless, and the people with low social and economic status are at higher risk of an unfavorable outcome in low incidence TB countries. Targeted actions to support this highly vulnerable population both in terms of outcome and occurrence of adverse events are needed.
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Genitourinary Tuberculosis: A Comprehensive Review of a Neglected Manifestation in Low-Endemic Countries. Antibiotics (Basel) 2021; 10:antibiotics10111399. [PMID: 34827337 PMCID: PMC8614939 DOI: 10.3390/antibiotics10111399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/02/2021] [Accepted: 11/12/2021] [Indexed: 12/15/2022] Open
Abstract
Genitourinary tuberculosis (GUTB) represents a disease often underestimated by urological specialists, particularly in settings such as the European one, where the pathology is less frequent. Similar to other uncommon diseases at these latitudes, GUTB is a neglected clinical problem. In this light, the aim of this review is to give a comprehensive overview of GUTB in order to provide a useful tool for urologists who seldomly manage this disease. A non-systematic review of genitourinary tuberculosis was performed on relevant articles published from January 1990 to July 2021 using PubMed, Scopus, and the Cochrane Central Register of Controlled Trials. GUTB represents up to a quarter of extrapulmonary tuberculosis (EPTB) cases. Diagnostic, therapeutic and surgical work-up have been deeply reviewed and summarized. The mass migration of refugees to Europe as well as the ease of international travel is gradually leading to an upsurge in urological diseases such as GUTB, which were previously only rarely encountered in some European countries. The poor TB knowledge of European urologists should be improved through medical education courses, webinars or telematic means.
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Mittal P, Ajmera P, Jain V, Aggarwal G. Modeling and analysis of barriers in controlling TB: developing countries' perspective. INTERNATIONAL JOURNAL OF HEALTH GOVERNANCE 2021. [DOI: 10.1108/ijhg-06-2021-0060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PurposeTuberculosis (TB) continues to c-exist with humans despite many TB control programs and elimination strategies. This depicts that some barriers are not allowing achieving the desired results. The current study aims to focus on identification and ranking of such barriers to facilitate TB control programs in developing countries.Design/methodology/approachIn the present study, 13 barriers that can influence success rate of TB elimination strategies have been recognized with an in-depth assessment of related literature and opinions of specialists from medical industry and academic world. The interpretive structural modeling (ISM) and decision-making trial and evaluation laboratory (DEMATEL) techniques have been employed for the ranking of barriers.FindingsBased on driving power of barriers, the study coined that underinvestment is a major barrier followed by poor implementation of government policies and programs, poverty and poor primary health care infrastructure.Research limitations/implicationsThe findings may guide healthcare service providers and researchers in analyzing the barriers and understanding the necessity of further advancements to decrease the count of already existing and incident cases.Practical implicationsPolicy- and decision-makers may utilize the information on dependence and driving power of barriers for better planning and effective execution of TB control strategies.Originality/valueAlthough a lot of literature is available on different barriers that are affecting success of TB strategies, the current study analyzes all the key barriers collectively for the prioritization of barriers.
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Trovik LH, Sandnes M, Blomberg B, Holmaas G, Ahmed AB, Tvedt THA, Vintermyr O, Reikvam H. Hemophagocytic lymphohistiocytosis and miliary tuberculosis in a previously healthy individual: a case report. J Med Case Rep 2020; 14:217. [PMID: 33172493 PMCID: PMC7655140 DOI: 10.1186/s13256-020-02555-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/11/2020] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Hemophagocytic lymphohistiocytosis (HLH) is a rare heterogenous genetic or acquired hyperinflammatory syndrome associated with a high degree of morbidity and mortality. HLH has clinical manifestations related to abnormal prolonged activation of T lymphocytes and macrophages with an excess of proinflammatory cytokines. The main causes of secondary HLH are malignancies and infectious diseases. CASE PRESENTATION The patient was a 54-year-old man, originally from Eastern Africa, who had lived in Northern Europe for 30 years. Here we describe the clinical features, laboratory parameters, diagnostic workup, management and outcome data of a previously healthy 54-year-old man diagnosed with HLH secondary to tuberculosis. The patient was initially treated for a community-acquired pneumonia. He developed multiorgan failure with acute respiratory distress syndrome, hypertransaminasemia, and kidney and bone marrow dysfunction. The clinical course together with a simultaneous increase in serum ferritin raised the suspicion of HLH. The patient fulfilled seven out of eight diagnostic criteria for HLH. A thorough diagnostic workup with respect to HLH and a potential underlying disease was initiated. Cultivation of bronchoalveolar lavage fluid, stool and urine, and polymerase chain reaction of epithelioid cell granulomas in the bone marrow were all positive for Mycobacterium tuberculosis. He was treated for both HLH and tuberculosis, and he survived without any sequelae. CONCLUSIONS We present one of few published cases of a patient who survived HLH triggered by miliary tuberculosis. The current case illustrates the need for awareness of these two diagnoses, and the timely initiation of specific and supportive treatment to reduce mortality.
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Affiliation(s)
| | - Miriam Sandnes
- Department of Clinical Science, Institute of Clinical Science, University of Bergen, Bergen, Norway
| | - Bjørn Blomberg
- Department of Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, Institute of Clinical Science, University of Bergen, Bergen, Norway
| | - Gunhild Holmaas
- Department of Surgical Services, Haukeland University Hospital, Bergen, Norway
| | | | | | - Olav Vintermyr
- Department of Pathology, Haukeland University Hospital, Bergen, Norway.,Departemnt of Medical Science, University of Bergen, Bergen, Norway
| | - Håkon Reikvam
- Department of Medicine, Haukeland University Hospital, Bergen, Norway. .,Department of Clinical Science, Institute of Clinical Science, University of Bergen, Bergen, Norway.
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Villa S, Riccardi N, Canetti D, Alagna R, Castellotti P, Ferrarese M, Cirillo D, Barberis I, Bragazzi NL, Gazzaniga V, Ricucci V, Codecasa LR, Besozzi G, Martini M. From the past, a long way to future challenges for a greater control of tuberculosis. Tuberculosis (Edinb) 2020; 123:101948. [PMID: 32741532 DOI: 10.1016/j.tube.2020.101948] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 04/15/2020] [Accepted: 05/10/2020] [Indexed: 02/06/2023]
Abstract
Tuberculosis (TB) and humans have coexisted for more than 40,000 years; however TB remains a global threat to human kind. The international community has developed new tools for early detection, but TB strains evolved acquiring resistance to first-line therapeutic drugs with increasing treatment challenges. Furthermore, TB has formed also an alliance with human immunodeficiency virus; in this way the poorest populations are most affected. The current vaccine planning activity includes 14 new vaccines against TB (11 of those in the phaseII/III) developed with different techniques. Now, more than ever, new anti-TB drugs and new anti-TB regimens are urgently required as well as universal health care and social protection in order to tackle down both hard to treat TB and the social determinants of TB. Coordinated actions and sharing of information are needed to aspire everywhere to the best clinical practices and improve quality of life of patients and their families.
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Affiliation(s)
| | - Niccolò Riccardi
- StopTB Italia Onlus, Milan, Italy; Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Diana Canetti
- StopTB Italia Onlus, Milan, Italy; Clinic of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Riccardo Alagna
- StopTB Italia Onlus, Milan, Italy; Emerging Bacterial Pathogens Unit, Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paola Castellotti
- StopTB Italia Onlus, Milan, Italy; Regional TB Reference Centre, Villa Marelli Institute/ASST Niguarda Ca' Granda, Milan, Italy
| | - Maurizio Ferrarese
- StopTB Italia Onlus, Milan, Italy; Regional TB Reference Centre, Villa Marelli Institute/ASST Niguarda Ca' Granda, Milan, Italy
| | - Daniela Cirillo
- StopTB Italia Onlus, Milan, Italy; Emerging Bacterial Pathogens Unit, Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ilaria Barberis
- StopTB Italia Onlus, Milan, Italy; Department of Health Sciences, University of Genoa, Genoa, Italy
| | | | - Valentina Gazzaniga
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | | | - Luigi Ruffo Codecasa
- StopTB Italia Onlus, Milan, Italy; Regional TB Reference Centre, Villa Marelli Institute/ASST Niguarda Ca' Granda, Milan, Italy
| | | | - Mariano Martini
- StopTB Italia Onlus, Milan, Italy; Department of Health Sciences, University of Genoa, Genoa, Italy.
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Wu L, Chang W, Song Y, Wang L. Predicting treatment failure risk in a Chinese Drug-Resistant Tuberculosis with surgical therapy: Development and assessment of a new predictive nomogram. Int J Infect Dis 2020; 96:88-93. [PMID: 32205286 DOI: 10.1016/j.ijid.2020.03.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 03/11/2020] [Accepted: 03/16/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The aim of this study was to develop and internally validate a treatment failure risk nomogram in a Chinese population of patients with Drug-Resistant Tuberculosis with surgical therapy. METHODS We developed a prediction model based on a dataset of 132 drug-resistant tuberculosis (DR-TB) patients. The least absolute shrinkage and selection operator regression model was used to optimize feature selection for the treatment failure risk model. Multivariable logistic regression analysis was applied to build a predicting model incorporating the feature selected in the least absolute shrinkage and selection operator regression model. Discrimination, calibration, and clinical usefulness of the predicting model were assessed using the C-index, calibration plot, and decision curve analysis. Internal validation was assessed using the bootstrapping validation. FINDINGS Predictors contained in the prediction nomogram included Lesion, Treatment history, Recurrent chest infection (RCI) and Multidrug-resistant tuberculosis (MDR-TB) or Extensively drug-resistant tuberculosis (XDR-TB). The model displayed good discrimination with a C-index of 0.905 and good calibration. A high C-index value of 0.876 could still be reached in the interval validation. Decision curve analysis showed that the nomogram was clinically useful when an intervention was decided at the treatment failure possibility threshold of 1%. INTERPRETATION This study developed a novel nomogram with relatively good accuracy to help clinicians access the risk of treatment failure in MDR/XDR-TB patients when starting surgery. With an estimate of individual risk, clinicians and patients can make more suitable decisions regarding surgery. This nomogram requires external validation, and further research is needed to determine whether the nomogram is appropriate for predicting surgery risk in MDR/XDR-TB patients.
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Affiliation(s)
- Liwei Wu
- Department of Thoracic Surgery, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Wei Chang
- The Center of Thoracic Surgery, Chest Hospital of Xinjiang Uyghur Autonomous Region, Urumqi, China
| | - Yanzheng Song
- Department of Thoracic Surgery, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China; TB Center, Shanghai Emerging & Re-emerging Infectious Diseases Institute, China.
| | - Lin Wang
- Department of Thoracic Surgery, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.
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