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Qi CC, Xu LR, Zhao CJ, Zhang HY, Li QY, Liu MJ, Zhang YX, Tang Z, Ma XX. Prevalence and risk factors of tuberculosis among people living with HIV/AIDS in China: a systematic review and meta-analysis. BMC Infect Dis 2023; 23:584. [PMID: 37674103 PMCID: PMC10481577 DOI: 10.1186/s12879-023-08575-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 08/29/2023] [Indexed: 09/08/2023] Open
Abstract
OBJECTIVE To estimate the prevalence and risk factors associated with tuberculosis (TB) among people living with human immunodeficiency virus (HIV) infection/acquired immunodeficiency syndrome (AIDS) in China. METHODS A systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. After the literature was screened based on the inclusion and exclusion criteria, STATA® version 17.0 software was used for the meta-analysis. The heterogeneity among study data was assessed using I2 statistics. Subgroup analysis and meta-regressions were performed to further explore the source of heterogeneity. RESULTS A total of 5241 studies were retrieved. Of these, 44 studies were found to be eligible. The pooled prevalence of HIV/TB co-infection was 6.0%. The risk factors for HIV/TB co-infection included a low CD4+ T cell count, smoking, intravenous drug use and several other sociodemographic and clinical factors. Bacillus Calmette-Guérin (BCG) vaccination history was a protective factor. CONCLUSION A high prevalence of TB was observed among people living with HIV/AIDS in China. Low CD4+ T cell count, smoking, and intravenous drug use were the primary risk factors for HIV/TB co-infection, whereas BCG vaccination history was a protective factor. Checking for TB should be prioritized in HIV screening and healthcare access. SYSTEMATIC REVIEW REGISTRATION Registered on PROSPERO, Identifier: CRD42022297754.
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Affiliation(s)
- Cong-Cong Qi
- Henan University of Chinese Medicine, Zhengzhou, Henan Province, China
| | - Li-Ran Xu
- Henan University of Chinese Medicine, Zhengzhou, Henan Province, China.
- Key Laboratory in Chinese Medicine for the Prevention and Treatment of Viral Diseases in Henan Province, Zhengzhou, Henan Province, China.
- The First Affiliated Hospital of Henan University of Chinese Medicine, Renmin Road 19, Jinshui District, Zhengzhou City, Henan Province, 450000, China.
| | - Chang-Jia Zhao
- Henan University of Chinese Medicine, Zhengzhou, Henan Province, China
| | - Hai-Yan Zhang
- Henan University of Chinese Medicine, Zhengzhou, Henan Province, China
| | - Qing-Ya Li
- Henan University of Chinese Medicine, Zhengzhou, Henan Province, China
| | - Mei-Jun Liu
- Henan University of Chinese Medicine, Zhengzhou, Henan Province, China
| | - Ye-Xuan Zhang
- Henan University of Chinese Medicine, Zhengzhou, Henan Province, China
| | - Zhou Tang
- Henan University of Chinese Medicine, Zhengzhou, Henan Province, China
| | - Xiu-Xia Ma
- The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan Province, China
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2
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Guo J, Liu ZD, Feng YP, Luo SR, Jiang QM. Assessment of Effective Anti-TB Regimens and Adverse Outcomes Related Risk Factors in the Elderly and Senile-Aged TB Patients. Infect Drug Resist 2023; 16:3903-3915. [PMID: 37361933 PMCID: PMC10289104 DOI: 10.2147/idr.s414918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/01/2023] [Indexed: 06/28/2023] Open
Abstract
Objective Compared to younger patients with tuberculosis (TB), elderly and senile-aged patients with TB had a higher incidence of adverse outcomes particularly in terms of lost to follow-up and deaths. Our study aimed to gain insight into the effectiveness of anti-tuberculosis (anti-TB) treatment in the elderly or senile-aged patients and identify the risk factors for adverse outcomes. Methods The case information was obtained from the "Tuberculosis Management Information System". From January 2011 to December 2021, this retrospective analysis was conducted in Lishui City, Zhejiang Province to observe and record the outcomes of elderly patients diagnosed with TB who agreed to receive anti-TB and(or) traditional Chinese medicine(TCM) treatment. We also employed a logistic regression model to analyze the risk factors for adverse outcomes. Results Among the 1191 elderly or senile-aged patients with TB who received the treatment, the success rate was 84.80% (1010/1191). Using logistic regression analysis, several risk factors for adverse outcomes (failure, death, loss to follow-up) were identified, including age ≥ 80 years (OR 2.186, 95% CI 1.517~3.152, P<0.001), lesion area ≥ 3 lung fields (OR 0.410, 95% CI 0.260~0.648, P<0.001), radiographic lesions failing to improve after 2 months of treatment (OR 2.048, 95% CI 1.302~3.223, P=0.002), sputum bacteriology failing to turn negative after 2 months of treatment (OR 2.213, 95% CI 1.227~3.990, P=0.008), lack of a standardized treatment plan (OR 2.095, 95% CI 1.398~3.139, P<0.001), and non-involvement of traditional Chinese medicine (OR 2.589, 95% CI 1.589~4.216, P<0.001). Conclusion The anti-TB treatment success rate in the elderly and senile-aged patients is suboptimal. Contributing factors include advanced age, extensive lesions, and low sputum negative conversion rate during the intensive treatment phase. The results will informative and could be useful for policy maker for to control of reemergence of TB in big cities.
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Affiliation(s)
- Jing Guo
- Department of Tuberculosis, Lishui Hospital of Traditional Chinese Medicine, Lishui, 323000, People’s Republic of China
| | - Zhong-Da Liu
- Department of Tuberculosis, Lishui Hospital of Traditional Chinese Medicine, Lishui, 323000, People’s Republic of China
| | - Yin-Ping Feng
- Department of Tuberculosis, Lishui Hospital of Traditional Chinese Medicine, Lishui, 323000, People’s Republic of China
| | - Shui-Rong Luo
- Department of Tuberculosis, Lishui Hospital of Traditional Chinese Medicine, Lishui, 323000, People’s Republic of China
| | - Qiao-Min Jiang
- Department of Tuberculosis, Lishui Hospital of Traditional Chinese Medicine, Lishui, 323000, People’s Republic of China
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Trigui M, Ben Ayed H, Koubaa M, Ben Hmida M, Ben Jmaa M, Yaich S, Ben Jmaa T, Hammami F, Fki H, Damak J, Ben Jemaa M. Tuberculosis in elderly: Epidemiological profile, prognosis factors and chronological trends in Southern Tunisia, 1995-2016. J Infect Prev 2022; 23:255-262. [PMID: 36277862 PMCID: PMC9583438 DOI: 10.1177/17571774221127540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 07/22/2021] [Accepted: 06/13/2022] [Indexed: 11/03/2023] Open
Abstract
Background Tuberculosis (TB) has become a public health problem among elderly in developing countries with the gradual increase in life expectancy. Aim/Objective This study aimed to analyze the prognosis factors and chronological trends of TB in elderly in Southern Tunisia. Methods A retrospective study was conducted. All TB patients aged ≥60 years, recorded in the Center of TB Control between 1995 and 2016, were included. Chronological trends of TB were analyzed by calculating the correlation coefficient of Spearman (Rho). Multivariate analysis was done by binary logistic regression (Adjusted Odds ratio (AOR); CI; p) to determine the independent risk factors associated with unsuccessful outcome in elderly. A p value <0.05 was considered as statistically significant. Results Overall, 512 new elderly TB cases were notified between 1995 and 2016, with an average of 23.3 new cases/year. The mean TB incidence rate for elderly was 2.31/100,000 population/year. The case-fatality rate of 8.6%. Multivariate analysis showed that factors independently associated with unsuccessful outcome among elderly patients were age between 80 and 89 (AOR = 4.5; [95% CI: 2, 10.2]; p < 0.001), male gender (AOR = 2.2; [95% CI: 1.1, 4.4]; p = 0.026) and neuro-meningeal involvement (AOR = 4.6; [95% CI: 1.4, 14.8]; p = 0.011). The incidence of TB in elderly patients increased significantly from 0.95/100,000 population in 1995 to 2.17/100,000 population in 2016 (Rho = 0.48; p = 0.024). Discussion A better understanding of TB features in elderly and its chronological trends overtime would facilitate to put in place, in the national TB control program, strategies geared towards this group of people.
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Affiliation(s)
- Maroua Trigui
- Department of Community Health and
Epidemiology, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
- Extra-pulmonary Tuberculosis Research
Unity, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Houda Ben Ayed
- Extra-pulmonary Tuberculosis Research
Unity, Hedi Chaker University Hospital, Sfax, Tunisia
- Department of Preventive Medicine and Hospital
Hygiene, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Makram Koubaa
- Extra-pulmonary Tuberculosis Research
Unity, Hedi Chaker University Hospital, Sfax, Tunisia
- Infectious Diseases Department, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Mariem Ben Hmida
- Department of Community Health and
Epidemiology, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
- Extra-pulmonary Tuberculosis Research
Unity, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Maissa Ben Jmaa
- Extra-pulmonary Tuberculosis Research
Unity, Hedi Chaker University Hospital, Sfax, Tunisia
- Department of Preventive Medicine and Hospital
Hygiene, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Sourour Yaich
- Department of Community Health and
Epidemiology, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Tarek Ben Jmaa
- Extra-pulmonary Tuberculosis Research
Unity, Hedi Chaker University Hospital, Sfax, Tunisia
- Infectious Diseases Department, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Fatma Hammami
- Extra-pulmonary Tuberculosis Research
Unity, Hedi Chaker University Hospital, Sfax, Tunisia
- Infectious Diseases Department, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Habib Fki
- Department of Preventive Medicine and Hospital
Hygiene, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Jamel Damak
- Department of Community Health and
Epidemiology, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Mounir Ben Jemaa
- Extra-pulmonary Tuberculosis Research
Unity, Hedi Chaker University Hospital, Sfax, Tunisia
- Infectious Diseases Department, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
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Raghu S. Challenges in treating tuberculosis in the elderly population in tertiary institute. Indian J Tuberc 2022; 69 Suppl 2:S225-S231. [PMID: 36400514 DOI: 10.1016/j.ijtb.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Abstract
Tuberculosis (TB) epidemic is most prevalent in the India with increase in mortality and morbidity. Ongoing elderly population as a result of increase in health care facilities are at high risk of TB. Elderly people are four-fold more prone to TB. Most cases of TB in the elderly result from reactivation of latent TB due to immunosenescence. Major challenge in dealing with therapeutic aspects of elderly patients is recognising frailty to prevent loss of independence. Challenges facing with elderly TB are difficult to reach out to hospital because of poor health seeking behaviour especially elderly female either due to ignorance or neglected by the family members, atypical presentation mimicking other disorders leading to diagnostic delay, if at all diagnosed impoverished tolerance and adherence to treatment due to various factors like associated comorbidities leading to pill load, impaired renal and hepatic functions with aging and stigma. Emerging resistance with usage of non-standard treatment regimens lead to unpropitious outcomes and increases mortality. The mortality rate is six times higher in elderly compared to younger individuals. Hence elderly people need tertiary level health care facilities for enhancing the diagnosis and appropriate management of tuberculosis and its complications. New set of guidelines to be made for elderly to increase adherence and tolerance thereby decreasing drug interactions and adverse drug reactions. With the increased prevalence of TB in the elderly, it is the need of the hour for India, to focus on this vulnerable population as they are a potential source of infection in the community. Awareness to be created among the elderly community regarding this deadly disease and its outcomes to increase their health consciousness and medical attention. Priming the special focus on females coterie as they are the most neglected population in our society.
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Affiliation(s)
- Srikanti Raghu
- Department of Pulmonary Medicine, Guntur Medical College, Guntur, Andhra Pradesh, India; Superintendent of Government Hospital for Chest and Communicable Diseases, Guntur, Andhra Pradesh, India.
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Cluster analysis categorizes five phenotypes of pulmonary tuberculosis. Sci Rep 2022; 12:10084. [PMID: 35710915 PMCID: PMC9203754 DOI: 10.1038/s41598-022-13526-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 05/17/2022] [Indexed: 01/27/2023] Open
Abstract
Tuberculosis (TB) has a heterogeneous phenotype, which makes it challenging to diagnose. Our study aimed to identify TB phenotypes through cluster analysis and compare their initial symptomatic, microbiological and radiographic characteristics. We systemically collected data of notified TB patients notified in Korea and constructed a prospective, observational cohort database. Cluster analysis was performed using K-means clustering, and the variables to be included were determined by correlation network. A total of 4,370 subjects with pulmonary TB were enrolled in the study. Based on the correlation network, age and body mass index (BMI) were selected for the cluster analysis. Five clusters were identified and characterised as follows: (1) middle-aged overweight male dominance, (2) young-aged relatively female dominance without comorbidities, (3) middle-aged underweight male dominance, (4) overweight elderly with comorbidities and (5) underweight elderly with comorbidities. All clusters had distinct demographic and symptomatic characteristics. Initial microbiologic burdens and radiographic features also varied, including the presence of cavities and bilateral infiltration, which reflect TB-related severity. Cluster analysis of age and BMI identified five phenotypes of pulmonary TB with significant differences at initial clinical presentations. Further studies are necessary to validate our results and to assess their clinical implications.
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Murali S, Krishnamoorthy Y, Knudsen S, Roy G, Ellner J, Horsburgh CR, Hochberg N, Salgame P, Prakash Babu S, Sarkar S. Comparison of profile and treatment outcomes between elderly and non-elderly tuberculosis patients in Puducherry and Tamil Nadu, South India. PLoS One 2021; 16:e0256773. [PMID: 34449817 PMCID: PMC8396735 DOI: 10.1371/journal.pone.0256773] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 08/13/2021] [Indexed: 11/29/2022] Open
Abstract
The rising geriatric population and the increased susceptibility of this age group to tuberculosis (TB), the deadliest single infectious agent, is bothersome for India. This study tried to explore the demographic and treatment outcome differences between the elderly (aged 60 years and above) and non-elderly TB (<60 years) patients from South India. This study was part of a large ongoing cohort study under the RePORT India consortium. Newly diagnosed TB patients recruited into the cohort between 2014 and 2018 were included in this study. Pretested and standardized questionnaire and tools were used to collect data and were stored securely for the entire cohort. Required demographic, anthropometric and treatment related variables were extracted from this database and analyzed using Stata version 14.0. Prevalence of elderly TB was summarized as percentage with 95% confidence interval (CI). Generalized linear modelling was attempted to find the factors associated with elderly TB. A total of 1,259 eligible TB patients were included into this present study. Mean (SD) of the participants in the elderly and non-elderly group was 65.8 (6.2) and 40.2 (12.0) respectively. Prevalence of elderly TB was 15.6% (95%CI: 13.6%-17.6%) with nearly 71% belonging to 60–69 age category. Male sex, OBC caste, poor education, unemployment, marriage, alcohol consumption and unable to work as per Karnofsky score were found to be significantly associated with an increased prevalence of elderly TB. Unfavorable outcomes (12% vs 6.5%, p value: 0.018), including death (9.3% vs 3.4%, p value: 0.001) were significantly higher among the elderly group when compared to their non-elderly counterparts. The current TB programme should have strategies to maintain follow up with due attention to adverse effects, social support and outcomes. Additional research should focus on predictors for unfavorable outcomes among the elderly TB group and explore ways to handle the same. Rendering adequate social support from the health system side and family side would be a good start.
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Affiliation(s)
- Sharan Murali
- Department of Preventive & Social Medicine, JIPMER, Puducherry, India
| | | | - Selby Knudsen
- Section of Infectious Diseases, Boston University School of Medicine, Boston, MA, United States of America
| | - Gautam Roy
- Department of Preventive & Social Medicine, JIPMER, Puducherry, India
| | - Jerrold Ellner
- Department of Medicine, Rutgers University, Newark, NJ, United States of America
| | - Charles Robert Horsburgh
- School of Public Health, Epidemiology & Biostatistics, Boston University, Boston, MA, United States of America
| | - Natasha Hochberg
- Section of Infectious Diseases, Boston University School of Medicine, Boston, MA, United States of America
| | - Padmini Salgame
- Department of Immunology, Rutgers University, Newark, NJ, United States of America
| | | | - Sonali Sarkar
- Department of Preventive & Social Medicine, JIPMER, Puducherry, India
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7
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Rousset S, Lafaurie M, Guet-Revillet H, Protin C, Le Grusse J, Derumeaux H, Gandia P, Nourhashemi F, Sailler L, Sommet A, Delobel P, Martin-Blondel G. Safety of Pyrazinamide for the Treatment of Tuberculosis in Older Patients Over 75 Years of Age: A Retrospective Monocentric Cohort Study. Drugs Aging 2020; 38:43-52. [PMID: 33145702 DOI: 10.1007/s40266-020-00811-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Pyrazinamide (PZA) has a controversial safety profile in older patients. We aimed to assess the frequency and risk factors for adverse drug reactions (ADRs) in patients over 75 years of age treated for tuberculosis with or without PZA. METHODS We conducted a retrospective monocentric study including patients aged over 75 years treated for active tuberculosis between 2008 and 2018. The frequency, type, seriousness, and causality assessment of ADRs to anti-tuberculosis treatment were compared between patients receiving PZA or not. Risk factors for ADRs were investigated using univariable and multivariable analyses by logistic regression. RESULTS Among the 110 patients included, 54 (49.1%) received PZA (group 1) and 56 (50.9%) did not (group 2). ADRs to anti-tuberculosis drugs occurred in 31 patients (57.4%) in groups 1 and 15 (26.8%) in group 2 (p = 0.003). PZA-related ADRs occurred in 40.7% of exposed patients. Frequency of renal ADRs was higher in group 1 (9.3% vs 0%; p = 0.026). Rates of hepatic (18.5% vs 12.5%; p = 0.38), digestive (22.2% vs 8.9%; p = 0.054), and allergic (14.8% vs 5.4%; p = 0.12) ADRs were numerically higher in group 1 although the differences were not statistically significant. Serious ADRs occurred more frequently in group 1 (24.1% vs 8.9%; p = 0.03). The use of PZA was the only independent risk factor for ADRs to anti-tuberculosis drugs (odds ratio 3.75, 95% CI 1.5-9.6; p = 0.0056). No risk factors for PZA-related ADRs were identified. CONCLUSION In older French patients, the use of PZA was associated with more frequent ADRs to anti-tuberculosis drugs.
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Affiliation(s)
- Stella Rousset
- Department of Infectious and Tropical Diseases, Toulouse University Hospital, Place du Docteur Baylac, TSA 40031, 31059, Toulouse Cedex 9, France.
| | - Margaux Lafaurie
- Clinical Pharmacology Department, Toulouse University Hospital, 37 Allées Jules Guesde, 31073, Toulouse Cedex, France.,INSERM UMR 1027, University of Toulouse III, 37 Allées Jules Guesde, 31000, Toulouse, France
| | - Hélène Guet-Revillet
- Department of Bacteriology, Toulouse University Hospital, 330 Avenue de Grande-Bretagne; TSA 40031, 31059, Toulouse Cedex 9, France
| | - Caroline Protin
- Department of Infectious and Tropical Diseases, Toulouse University Hospital, Place du Docteur Baylac, TSA 40031, 31059, Toulouse Cedex 9, France
| | - Jean Le Grusse
- Tuberculosis Control Centre, Joseph Ducuing Hospital, 15 Rue de Varsovie, BP 53160, 31027, Toulouse Cedex 3, France
| | - Hélène Derumeaux
- Medical Information Department, Toulouse University Hospital, Place du Docteur Baylac, TSA 40031, 31059, Toulouse Cedex 9, France
| | - Peggy Gandia
- Clinical Pharmacokinetics Laboratory, Toulouse University Hospital, Place du Docteur Baylac, TSA 40031, 31059, Toulouse Cedex 9, France
| | - Fatemeh Nourhashemi
- Department of Geriatrics, Toulouse University Hospital, Place Lange, TSA 60033, 31059, Toulouse Cedex 9, France.,INSERM UMR 1027, University of Toulouse III, 37 Allées Jules Guesde, 31000, Toulouse, France
| | - Laurent Sailler
- Department of Internal Medicine, Place du Docteur Baylac, Toulouse University Hospital, TSA 40031, 31059, Toulouse cedex 9, France
| | - Agnès Sommet
- Clinical Pharmacology Department, Toulouse University Hospital, 37 Allées Jules Guesde, 31073, Toulouse Cedex, France.,INSERM UMR 1027, University of Toulouse III, 37 Allées Jules Guesde, 31000, Toulouse, France
| | - Pierre Delobel
- Department of Infectious and Tropical Diseases, Toulouse University Hospital, Place du Docteur Baylac, TSA 40031, 31059, Toulouse Cedex 9, France.,INSERM U1043, CNRS UMR 5282, Centre de Physiopathologie Toulouse-Purpan, Place du Docteur Baylac, TSA 40031, 31059, Toulouse Cedex 9, France
| | - Guillaume Martin-Blondel
- Department of Infectious and Tropical Diseases, Toulouse University Hospital, Place du Docteur Baylac, TSA 40031, 31059, Toulouse Cedex 9, France.,INSERM U1043, CNRS UMR 5282, Centre de Physiopathologie Toulouse-Purpan, Place du Docteur Baylac, TSA 40031, 31059, Toulouse Cedex 9, France
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Koo HK, Min J, Kim HW, Lee J, Kim JS, Park JS, Lee SS. Prediction of treatment failure and compliance in patients with tuberculosis. BMC Infect Dis 2020; 20:622. [PMID: 32831044 PMCID: PMC7446045 DOI: 10.1186/s12879-020-05350-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/16/2020] [Indexed: 11/20/2022] Open
Abstract
Background To improve treatment outcomes for tuberculosis (TB), efforts to reduce treatment failure are necessary. The aim of our study was to describe the characteristics of subjects who had failed treatment of tuberculosis and identify the risk factors for treatment failure and poor compliance using national data. Methods A multicenter cross-sectional study was performed on tuberculosis subjects whose final outcome was reported as treatment failure during 2015–2017. The same number of subjects with treatment success during the same study period were randomly selected for comparison. Demographics, microbiological, radiographic, and clinical data were collected based on in-depth interviews by TB nurse specialists at all Public Private Mix (PPM) participating hospitals in South Korea. Results A total of 52 tuberculosis patients with treatment failure were enrolled. In a multivariable analysis, the presence of diabetes, previous history of tuberculosis, and cavity were identified as risk factors for treatment failure; and Medicaid support was a favorable factor for treatment success (area under the curve [AUC]: 0.79). Age, low body mass index (BMI), presence of diabetes, preexisting lung disease, positive sputum acid-fast bacilli (AFB) smear result, and the presence of multidrug-resistant tuberculosis (MDR-TB) were significantly associated with presence of cavities. Younger age, lower BMI and previous history of TB were associated with poor compliance during treatment (AUC: 0.76). Conclusion To reduce treatment failure, careful evaluation of the presence of diabetes, previous TB history, underlying lung disease, cavity, results of sputum AFB smears, and socioeconomic status are needed. To enhance treatment compliance, more attention should be paid to younger patients with lower BMIs during follow-up.
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Affiliation(s)
- Hyeon-Kyoung Koo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Juhwa-ro 170, Ilsanseo-gu, Goyang, 10380, Republic of Korea
| | - Jinsoo Min
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyung Woo Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joosun Lee
- Division of TB Epidemic Investigation, Korea Centers for Disease Control and Prevention, Osong, Republic of Korea
| | - Ju Sang Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae Seuk Park
- Division of Pulmonary Medicine, Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Sung-Soon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Juhwa-ro 170, Ilsanseo-gu, Goyang, 10380, Republic of Korea.
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9
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Konno A, Narumoto O, Matsui H, Takeda K, Hirano Y, Shinfuku K, Tashimo H, Kawashima M, Yamane A, Tamura A, Nagai H, Ohta K, Tohma S. The benefit of stool mycobacterial examination to diagnose pulmonary tuberculosis for adult and elderly patients. J Clin Tuberc Other Mycobact Dis 2019; 16:100106. [PMID: 31720430 PMCID: PMC6830132 DOI: 10.1016/j.jctube.2019.100106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background In patients with suspected pulmonary tuberculosis, who have difficulty in expectorating sputum, alternative specimens by invasive procedures, gastric aspirate or sputum suction, are not always available in the feeble elderly. Several studies report the benefit of stool test for pediatric or HIV infected patients, but few in adult patients. Objective To evaluate the benefit of stool examination as non-invasive alternative test to detect Mycobacterium tuberculosis (MTB) infection. Methods Stool specimens were examined for mycobacteria in 187 cases of microbiologically-diagnosed pulmonary tuberculosis between September 2013 and August 2017. We retrospectively reviewed the medical records to determine the positive detection rate of MTB with stool specimens and investigated factors related to MTB detection. Results Among 187 patients included, positive rate of MTB in stool was 12.8% (24/187) by stool acid-fast bacilli smear, 68.1% (98/144) by TRC Rapid®, and 40.6% (76/187) by culture. Multivariate logistic regression analysis revealed two contributing factors to MTB detection in stool; cavitation and male. The adjusted odds ratio with 95% confidence interval (CI) for cavitation was 2.9 (95%CI 1.48–5.69) and 2.1 (95%CI 1.08–3.93) for male. Conclusion We recommend stool examination for those who are unable to give sputum and have risks for invasive procedures.
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Affiliation(s)
- Aya Konno
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Takeoka 3-1-1, Kiyose, Tokyo, Japan
| | - Osamu Narumoto
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Takeoka 3-1-1, Kiyose, Tokyo, Japan
- Corresponding author.
| | - Hirotoshi Matsui
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Takeoka 3-1-1, Kiyose, Tokyo, Japan
| | - Keita Takeda
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Takeoka 3-1-1, Kiyose, Tokyo, Japan
- Department of Basic Mycobacteriology, Graduate School of Biomedical Science, Nagasaki University, Japan
| | - Yuta Hirano
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Takeoka 3-1-1, Kiyose, Tokyo, Japan
| | - Kyota Shinfuku
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Takeoka 3-1-1, Kiyose, Tokyo, Japan
| | - Hiroyuki Tashimo
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Takeoka 3-1-1, Kiyose, Tokyo, Japan
| | - Masahiro Kawashima
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Takeoka 3-1-1, Kiyose, Tokyo, Japan
| | - Akira Yamane
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Takeoka 3-1-1, Kiyose, Tokyo, Japan
| | - Atsuhisa Tamura
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Takeoka 3-1-1, Kiyose, Tokyo, Japan
| | - Hideaki Nagai
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Takeoka 3-1-1, Kiyose, Tokyo, Japan
| | - Ken Ohta
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Takeoka 3-1-1, Kiyose, Tokyo, Japan
- JATA Fukujuji Hospital, Japan
| | - Shigeto Tohma
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Takeoka 3-1-1, Kiyose, Tokyo, Japan
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10
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Oshi DC, Oshi SN, Alobu I, Ukwaja KN. Profile and treatment outcomes of tuberculosis in the elderly in southeastern Nigeria, 2011-2012. PLoS One 2014; 9:e111910. [PMID: 25369001 PMCID: PMC4219797 DOI: 10.1371/journal.pone.0111910] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 10/02/2014] [Indexed: 12/14/2022] Open
Abstract
Background The demographic transition and increasing life expectancy in Africa has lead to a rising elderly population. In Nigeria, little is known about the profile of and treatment outcomes of tuberculosis (TB) in the elderly. Methods Retrospective cohort study of adult TB patients treated between January 2011 and December 2012 in two large health facilities in Nigeria. The demographic, clinical and treatment outcomes of patients aged 60 and older were compared with those aged 15 to 59 years. Results Elderly (≥60 years) TB patients accounted for 12.7% of all (1668) adult TB enrolled. Elderly patients had a higher proportion of men compared to non-elderly (64.2% vs 56.8%; p = 0.043); but a lower proportion of smear-positive TB at baseline (40.7% vs 65.8%; p<0.001). A higher proportion of elderly patients failed to smear convert after the intensive phase of treatment (23.7% vs 19.8%; p = 0.06), and overall elderly patients had lower treatment success rates (68.9% vs 77.1%; p = 0.009). Unsuccessful outcomes were mainly due to higher default and deaths in the elderly. The risk factors for unsuccessful outcomes in the elderly were: extrapulmonary TB case (adjusted odds ratio (aOR) 10.9; 95% confidence interval (CI) 1.1–108), and HIV co-infection (aOR 3.6; CI 1.1–11.7). Conclusions Treatment outcomes of elderly TB patients were inferior to non-elderly adults with higher death and default rates being implicated. With the rising elderly population, specific strategies are needed to quickly address TB management in the elderly in resource-limited settings.
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Affiliation(s)
- Daniel C. Oshi
- Centre for Development and Reproductive Health, Enugu, Enugu State, Nigeria
| | - Sarah N. Oshi
- Centre for Development and Reproductive Health, Enugu, Enugu State, Nigeria
| | - Isaac Alobu
- National Tuberculosis and Leprosy Control Programme, Ministry of Health, Abakaliki, Ebonyi State, Nigeria
| | - Kingsley N. Ukwaja
- Department of Internal Medicine, Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
- * E-mail:
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11
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Yone EWP, Kengne AP, Moifo B, Kuaban C. Prevalence and determinants of extrapulmonary involvement in patients with pulmonary tuberculosis in a Sub-Saharan African country: a cross-sectional study. ACTA ACUST UNITED AC 2012; 45:104-11. [PMID: 22992019 DOI: 10.3109/00365548.2012.714905] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Determinants of extrapulmonary involvement during pulmonary tuberculosis (PTB) have not been extensively investigated. We assessed the prevalence and determinants of extrapulmonary involvement during PTB in a Sub-Saharan African country with a high prevalence of both TB and human immunodeficiency virus (HIV) infection. METHODS The medical records of patients aged ≥ 15 y, admitted for a first episode of TB to the Pneumology Service of Yaoundé Jamot Hospital, Cameroon, between 2009 and 2010 were considered. Determinants of extrapulmonary involvement were investigated through logistic regression. RESULTS A total of 984 patients (58.9% male), with a median age (25(th)-75(th) percentiles) of 32 (25-41) y were admitted for a first episode of TB, including 629 (63.9%) with isolated PTB, 127 (12.9%) with isolated extrapulmonary TB (EPTB), and 228 (23.2%) with both PTB and EPTB (PTB/EPTB). Therefore, the prevalence of EPTB among those with PTB was 26.6% (228/857). The main determinants of EPTB among patients with PTB were male sex (adjusted odds ratio (OR) 2.71, 95% confidence interval (95% CI) 1.71-4.03), HIV infection (OR 2.20, 95% CI 1.36-3.55), absence of fibrotic lung lesions (OR 1.96, 95% CI 1.23-3.14), smear-negative PTB (OR 7.20, 95% CI 4.13-12.56), anaemia (OR 1.60, 95% CI 1.03-2.50), and leukopenia (OR 2.59, 95% CI 1.12-5.98). CONCLUSIONS About a quarter of patients with PTB in this setting also have extrapulmonary involvement. EPTB is less contagious, less frequent than PTB, and less well addressed by programs in developing countries, while its identification is important for optimizing care. The presence of determinants of EPTB among patients with PTB should motivate active investigation of extrapulmonary involvement in order to improve management.
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Affiliation(s)
- Eric Walter Pefura Yone
- Department of Internal Medicine and Subspecialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon.
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12
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Schluger NW. Tuberculosis and nontuberculous mycobacterial infections in older adults. Clin Chest Med 2008; 28:773-81, vi. [PMID: 17967293 DOI: 10.1016/j.ccm.2007.07.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Tuberculosis is one of the world's great public health crises. It is estimated by the World Health Organization that roughly one third of the world's populations, or some 2 billion people, are infected with Mycobacterium tuberculosis, the causative agent. More than 8 million people every year develop active tuberculosis disease, and 2 million die as a result. This article reviews tuberculosis and nontuberculous mycobacterial infections in older adults.
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Affiliation(s)
- Neil W Schluger
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center, Epidemiology and Environmental Health Sciences, Mailman School of Public Health, 722 West 168th Street, New York, NY 10032, USA.
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Abstract
Evaluation of elderly patients who have fever of unknown origin (FUO) requires a different perspective from that needed for young patients. Differential diagnosis often varies with age, and presentation of the disease frequently is nonspecific and symptoms difficult to interpret. Noninfectious diseases are the most frequent cause of FUO in the elderly and temporal arteritis the most frequent specific cause. Tuberculosis is the most common infectious disease associated with FUO in elderly patients. FUO often is associated with treatable conditions in the elderly. Therefore, intensive, accelerated evaluation is necessary, as the lack of physiologic reserve makes this population vulnerable to irreversible changes and functional deterioration.
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Affiliation(s)
- Sari Tal
- Subacute Department, Harzfeld Geriatric Hospital, Kaplan Medical Center, Gedera, Israel.
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15
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Oliveira HBD, Marín-León L, Cardoso JC. Perfil de mortalidade de pacientes com tuberculose relacionada à comorbidade tuberculose-Aids. Rev Saude Publica 2004; 38:503-10. [PMID: 15311289 DOI: 10.1590/s0034-89102004000400004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Analisar o perfil dos óbitos entre pacientes com tuberculose, e descrever a co-infecção tuberculose-Aids e a causa básica de morte nas coortes anuais. MÉTODOS: Foi realizado estudo descritivo dos indivíduos residentes na cidade de Campinas, SP, que foram a óbito durante o tratamento para tuberculose e também dos pacientes notificados após o óbito, mesmo sem ter iniciado o tratamento. As informações foram obtidas do Banco de Dados em Tuberculose /Universidade Estadual de Campinas (Unicamp) e do Banco de Óbitos da Secretaria Municipal de Saúde/Unicamp. Para análise estatística utilizou-se o software Epi Info versão 6. Os óbitos foram agrupados em dois períodos (1993-1996 e 1997-2000) e as proporções, comparadas. RESULTADOS: Foram notificados 4.680 pacientes, totalizando 737 óbitos, com coeficiente de letalidade de 18,1%, de 1993 a 1996, e 13,5%, de 1997 a 2000. Em 78 óbitos (10,6%) a notificação foi no post mortem e não chegou a ser instituído tratamento específico. Verificou-se predomínio do sexo masculino (71,3%) nos dois períodos estudados. A comorbidade tuberculose-Aids esteve presente em 55% dos óbitos. O perfil etário diferiu segundo a presença ou não da Aids: em ambos os períodos, a mediana da idade nos óbitos com Aids esteve na faixa de 30 a 39 e entre 50 e 59 naqueles sem Aids. Os pacientes que nunca haviam sido tratados de tuberculose representaram 81,3% CONCLUSÕES: Destaca-se entre os achados a marcante redução do número de óbitos, a partir de 1997, que pode estar relacionada com a utilização da terapia anti-retroviral (HAART) para Aids.
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Affiliation(s)
- Helenice Bosco de Oliveira
- Departamento de Medicina Preventiva e Social, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil.
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Wong CMM, Lim KH, Liam CK. The causes of haemoptysis in malaysian patients aged over 60 and the diagnostic yield of different investigations. Respirology 2003; 8:65-8. [PMID: 12856744 DOI: 10.1046/j.1440-1843.2003.00437.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE In southeast Asia, pulmonary tuberculosis (TB) is the most frequently presumed diagnosis for haemoptysis. This study was designed to assess the causes of haemoptysis, the diagnostic yield of causes in different diagnostic modalities and the distribution of older patients. METHODS All patients presenting to the University of Malaya Medical Centre, Kuala Lumpur, Malaysia with haemoptysis were recruited prospectively and evaluated. RESULTS One hundred and sixty patients were evaluated for haemoptysis; 71 (44.4%) were aged 60 years or more. Significantly more patients smoked in the older age group (P = 0.002). The main causes of haemoptysis in the older patients were bronchogenic carcinoma (49.3%), pneumonia (11.3%), bronchiectasis (8.6%), cryptogenic (5.6%) and active TB (4.2%). Significantly more older patients had carcinoma (P < 0.001), while the younger patients more often had TB (P < 0.001). Chest pain was significantly more common in the older patients (P = 0.025), particularly in patients with carcinoma. Bronchoscopy alone or combined with CT of the thorax was significantly more diagnostic in the older patient (P = 0.006). CONCLUSION Bronchogenic carcinoma is the commonest cause of haemoptysis in patients aged 60 years and above. Presumptive anti-TB therapy should not be encouraged despite the regional high prevalence of TB.
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Affiliation(s)
- Catherine Mee-Ming Wong
- Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, 50603 Kuala Lumpur, Malaysia.
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Abstract
Fever of unknown origin (FUO) means fever that does not resolve itself in the period expected for self-limited infection and whose cause cannot be ascertained despite considerable diagnostic efforts. The differential diagnosis is often different in older patients, and presentation of disease is frequently nonspecific and symptoms are difficult to interpret. Multisystem disease has emerged as the most frequent cause of FUO in the elderly, and temporal arteritis is the most frequent specific diagnosis. Infections, particular tuberculosis, remain an important group. FUO is often associated with treatable conditions in this age group. Early recognition and prompt initiation of appropriate empirical therapy are cornerstones of the strategy.
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Affiliation(s)
- S Tal
- Subacute Department, Harzfeld Geriatric Hospital, Kaplan Medical Center, Gedera 70750, Israel.
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18
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Lutters M, Vogt N. What's the basis for treating infections your way? Quality assessment of review articles on the treatment of urinary and respiratory tract infections in older people. J Am Geriatr Soc 2000; 48:1454-61. [PMID: 11083323 DOI: 10.1111/j.1532-5415.2000.tb02637.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the quality of readily available review articles on urinary and respiratory tract infections in older people. METHODS Data sources were articles identified by MEDLINE search (1988-1998), review of the bibliographies of identified publications, textbooks from the library of a geriatric university hospital, and booklets with general guidelines on antibiotic therapy. Selection was made of review articles or book chapters about urinary and/or respiratory tract infections in older people that were readily available, ie, in Swiss medical libraries. Quality was assessed according to clinical applicability of the recommendations, methodology of the review, type of literature cited in the bibliography, and age of the population included in these reference articles. RESULTS Only 13 of 29 (45%) review articles about urinary tract infections and seven of 29 (24%) articles about respiratory tract infections satisfied our criteria of applicability. Specifically, dosage, route of administration, and treatment duration were often not described. The overall methodological quality was low (mean score 1.9 +/- 1.0 on a scale of 9). No review specified the methods used to identify, select, and validate included information. Authors of the review articles quoted an important number of other review articles and only a small number of clinical trials. Less than one-quarter of these clinical trials actually comprised primarily an older population. CONCLUSIONS Review articles on treatment of common infectious diseases in older people are often neither clinically applicable nor of good methodological quality. Therefore, more systematic review articles regarding treatment of older patients, as well as evidence-based practice guidelines, are needed.
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Affiliation(s)
- M Lutters
- Department of Geriatrics, University Hospitals of Geneva, Switzerland
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Affiliation(s)
- Y Elad
- Department of Medicine, Mount Sinai School of Medicine, New York, NY 10029-6574, USA
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