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Di Gennaro F, Cotugno S, Fasano M, Ricciardi A, Ronga L, Lattanzio R, Grimaldi A, Bavaro DF, Ciarallo M, Garzone S, De Iaco G, Guido G, Fiore JR, Brindicci G, Santoro CR, Sica S, Iacovazzi TL, Santantonio TA, Saracino A. High risk of unsuccessful treatment outcome in migrant population with tuberculosis: Data from three Italian hospitals. Front Public Health 2023; 10:1024474. [PMID: 36703820 PMCID: PMC9871451 DOI: 10.3389/fpubh.2022.1024474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 12/09/2022] [Indexed: 01/11/2023] Open
Abstract
Introduction Tuberculosis (TB) remains an unresolved global health problem and vulnerable groups such as migrants remain the most affected with a higher risk of worse outcomes. The aim of this study was to evaluate clinical features, outcomes, and adverse events in migrant and native Italian patients admitted to three Italian hospitals in Southern Italy in order to assess differences and targeted strategies. Methods We performed a retrospective study on TB patients admitted between January 1, 2013, and December 31, 2021, in three Apulia hospitals. Two logistic regression models were used, with the dependent variables being (I) unsuccessful treatment (died, loss to follow-up, and failed treatment) and (II) adverse events. Results We enrolled 543 consecutive patients admitted at three Italian hospitals with a diagnosis of TB during the study period, of them 323 (59.5%) were migrants and 220 Italian patients. The treatment success rate in the migrant group was 44.9% (137/305), while in the non-migrant group was 97.1% (203/209). Independent factors of unsuccess treatment (death, failure or loss to follow up) were: migrant status (O.R. = 11.31; 95% CI 9.72-14.23), being male (O.R. = 4.63; 95% CI 2.16-6.10), homelessness (O.R. = 3.23; 95% CI 2.58-4.54), having a MDR (Multidrug-resistant) (O.R = 6.44; 95% CI 4.74-8.23), diagnostic delay (O.R. = 3.55; 95% CI 1.98-5.67), and length of hospitalization (O.R. = 3.43; 95% CI 1.88-5.87). While, age >65 ys (O.R. = 3.11; 95% CI 1.42-4.76), presence of extrapulmonary TB (O.R. = 1.51; 95% CI 1.31-2.18), monoresistance (O.R. = 1.45; 95% CI 1.25-3.14) and MDR pattern (O.R. = 2.44; 95% CI 1.74-5.03) resulted associated with adverse events. Conclusion Migrant population is at high risk of unsuccessful treatment (death, loss to follow-up, and treatment failure). Policies targeted specifically to this group are needed to really impact and improve their health status and also to contain the TB burden.
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Affiliation(s)
- Francesco Di Gennaro
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
| | - Sergio Cotugno
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy,*Correspondence: Sergio Cotugno ✉
| | - Massimo Fasano
- Unità Operativa Complessa (UOC) Infectious Diseases Azienda Sanitaria Locale Bari (ASL BA), Bari, Italy
| | - Aurelia Ricciardi
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
| | - Luigi Ronga
- Microbiology and Virology Unit, University Hospital Policlinico, University of Bari, Bari, Italy
| | - Rossana Lattanzio
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
| | - Anna Grimaldi
- Chemical-Clinical and Microbiological Research Unit, ASL BA, Bari, Italy
| | - Davide Fiore Bavaro
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
| | - Marianna Ciarallo
- Infectious Diseases Unit, Department of Clinical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Stefania Garzone
- Microbiology and Virology Unit, University Hospital Policlinico, University of Bari, Bari, Italy
| | - Giuseppina De Iaco
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
| | - Giacomo Guido
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
| | - Josè Ramon Fiore
- Infectious Diseases Unit, Department of Clinical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Gaetano Brindicci
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
| | - Carmen Rita Santoro
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
| | - Salvatore Sica
- Infectious Diseases Unit, Department of Clinical and Surgical Sciences, University of Foggia, Foggia, Italy
| | | | - Teresa Antonia Santantonio
- Infectious Diseases Unit, Department of Clinical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Annalisa Saracino
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
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