Faktori rizika za nastanak multirezistentne tuberkuloze: studija slučajeva i kontrola

Abstract

U većini studija identifikovano je da je neadekvatna terapija glavni uzrok nastanka multirezistentne tuberkuloze (MDR-TB) tj. tuberkuloze (TB) izazvane sojem bakterije Mycobacterium tuberculosis koji je rezistentan na izoniazid i rifampicin. Međutim, najnovija istraživanja ukazuju da brojne socijalne determinante doprinose pojavi MDR-TB. Cilj ove studije je bio da se identifikujui nezavisni faktori za nastanak MDR-TB kod obolelih od TB. Metod: Studija slučajeva i kontrola je sprovedena od 1. septembra 2009. do 1. juna 2014. godine u 31 zdravstvenoj ustanovi u Srbiji u kojoj su se lečili oboleli od MDR-TB i TB. Rezistencija na rifampicin i izoniazid je dijagnostikovana korišćenjem čvrstih ili tečnih medijuma ili izvođenjem molekularnog testa za detekciju TB DNK. Oboleli od MDR-TB (31 ispitanik) mečovani su prema datumu hospitalizacije sa kontrolama ( osobe sa TB - 93 ispitanika). Podaci su prikupljeni korišćenjem upitnika putem intervuja licem u lice. Univarijantna (ULRA) i multivarijantna logistička regresiona analiza (MLRA) su korišćene za identifikaciju značajnih nezavisnih faktora povezanih sa MDR-TB. Rezultati: U studiji je učestvovalo ukupno 124 ispitanika, 31 oboleli i 93 kontrole. Prema rezultatima ULRA sa multirezistentnom tuberkulozom su bile statistički značajno povezane sledeće varijable: mesečni prihod porodice (OR = 5.00, CI = 1.74-14.35), upotreba sredstava za uspavljivanje (OR = 3.39, CI = 1.32-8.67), upotreba smirujućih sredstava (OR = 3.89, CI = 1.53-9.86), prisustvo subjektivnog osećaja nervoze (OR = 3.34, CI = 1.36-8.17), prisustvo subjektivnog osećaja tuge (OR = 3.88, CI = 1.63-9.24), iskustvo stresnih situacija u poslednjih 12 meseci (OR = 2.88, CI = 1.16-7.09), stigma (OR = 3.32, CI = 1.40-7.86), prethodno lečenje TB (OR = 2.65, CI = 1.14-6.16), prekidi u lečenju TB (OR = 3.84, CI = 1.41-11.11), i hronična opstruktivna bolest pluća (OR = 5.34, CI = 1.39-20.40)...

Multidrug resistant (MDR) tuberculosis (TB) represents TB which is simultaneous resistant to at least rifampicin (R) and isoniazid (H). Identifying inadequate therapy as the main cause of this form of the disease and explaining the factors leading to its occurrence, numerous social determinants that affect the risk of developing resistance are highlighted. The objective of the study was to identify independent factors of MDR-TB among TB patients. Method: Case-control study was conducted from 1st September 2009 to 1st June 2014 in 31 healthcare institutions in Serbia where MDR-TB and TB patients were treated. Resistance to rifampicin and isoniazid were detected using solid or liquid media or by performing a molecular test to detect TB DNA. TB patients infected with MDR and non MDR M. tuberculosis strain were considered as cases and controls, respectively and matched by the date of hospitalization. The data was collected using questionnaire in face to face interview. Bivariate and multivariable logistic regression analyses (MLRA) were used to identify determinants associated with MDR TB. Results: A total of 124 respondents, 31 cases and 93 controls were participated in the study. According to ULRA, following variables were statistically significantly associated with MDR-TB: monthly income of the family (OR = 5.00, CI = 1.74-14.35), use of sleeping agents (OR = 3.39, CI = 1.32-8.67), use of calming agents = 3.89, CI = 1.53-9.86), the presence of a subjective feeling of nervousness (OR = 3.34, CI = 1.36-8.17), the presence of a subjective feeling of sorrow (OR = 3.88, CI = 1.63-9.24), experience of stressful situations in the last 12 months OR = 2.88, CI = 1.16-7.09), stigma (OR = 3.32, CI = 1.40-7.86), previous TB treatment (OR = 2.65, CI = 1.14-6.16), interruptions in TB treatment (OR = 3.84, 1.41-11.11), and chronic obstructive pulmonary disease (OR = 5.34, CI = 1.39-20.40)...