oa Southern African Journal of Epidemiology and Infection - Managing multidrug-resistant tuberculosis in hospitalised patients : a review of treatment outcomes
The admission trends, management practices, and interim treatment outcomes of multidrug-resistant tuberculosis (MDR-TB) patients admitted in a specialised referral hospital in Johannesburg were reviewed. A cross-sectional study with both descriptive and analytic features was done on 237 MDR-TB patients hospitalised from the beginning of June 1998 to the end of May 2003. Data were analysed using SPSS version 12 software. Main interim outcome measures after in-patient care were protracted hospitalisation, transfer out, absconding, and death rates. Multiple logistic regression analysis was performed to determine risk factors for poor treatment outcomes. The allocated hospital beds were insufficient for patients meeting the in-patient care criteria. Nearly half of the patients were hospitalised on suspicion of MDR-TB based on contact history and persistency of positive sputum despite treatment for drug-susceptible TB. With regard to the period between confirmation of MDR-TB and admission, patients with primary MDR-TB were more likely to be hospitalised shortly after diagnosis. Acquired MDR-TB patients were mostly managed as out-patients immediately after diagnosis only to be hospitalised later due to persistent non-adherence or disease severity. Overall, acquired MDR-TB patients were hospitalised in larger numbers than those with primary disease. This reflects the higher prevalence of acquired MDR-TB. Hospitalisation did not guarantee adherence to treatment with patients declining or hiding the medications. Surgical interventions were done belatedly with resultant high mortality outcomes. A large percentage of patients were co-infected with HIV. Antiretroviral drugs (ARVs) were not readily available to patients at the time of study. The hospital should provide ARVs and formulate admission and discharge guidelines. Continuing education for service providers must be encouraged and infection control procedures at all levels ought to be vigorously promoted. Patients known to be non-adherent to treatment should be partially hospitalised in the interest of public health.
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