Abstract
BackgroundPatients with a history of tuberculosis (TB) have a high probability of recurrence because long-term cure is not always maintained in successfully treated patients. The aim of this study was to identify the probability of TB recurrence and its predictive factors in a cohort of socially vulnerable patients who completed treatment in the TB referral center in Catalonia, which acts as the center for patients with social and health problems.MethodsThis retrospective open cohort study included all patients diagnosed with TB who were admitted and successfully treated in Serveis Clínics between 2000 and 2016 and who remained disease-free for a minimum of 1 year after treatment completion. We calculated the incidence density of TB recurrences per person-years of follow-up. We also estimated the cumulative incidence of TB recurrence at 1, 2, 5, and 10 years of follow-up. Bivariate analysis was conducted using Kaplan-Meier curves. Multivariate analysis was conducted using Cox regression. Hazard ratios (HR) were calculated with their 95% confidence intervals (95%CI).ResultsThere were 839 patients and 24 recurrences (2.9%), representing 0.49 per 100 person-years. The probability of a recurrence was 0.63% at 1 year of follow-up, 1.35% at 2 years, and 3.69% at 5 years. The multivariate analysis showed that the predictive factors of recurrence were age older than 34 years (aHR = 3.90; CI = 1.06–14.34 at age 35–45 years and aHR = 3.88; CI = 1.02–14.80 at age >45 years) and resistance to at least one anti-TB drug (aHR = 2.91; CI = 1.11–7.65).ConclusionsAttention should be paid to socially vulnerable persons older than 34 years with a previous episode of resistant TB. Surveillance resources should be directed toward adequately treated patients who nevertheless have a high risk of recurrence.
Highlights
In 2017, there were an estimated 10 million people with tuberculosis (TB) worldwide
Tuberculosis recurrences in vulnerable population to have access to the databases used to carry out the study
Considerable progress has been made in the last few years, the main obstacles to controlling the infection are human immunodeficiency virus (HIV), the increase in antibiotic resistance, and the problem of TB in large cities associated with socially vulnerable populations at risk of social exclusion, such as drug users, alcoholics, and economic immigrants [1,2,3,4]
Summary
In 2017, there were an estimated 10 million people with tuberculosis (TB) worldwide. considerable progress has been made in the last few years, the main obstacles to controlling the infection are human immunodeficiency virus (HIV), the increase in antibiotic resistance, and the problem of TB in large cities associated with socially vulnerable populations at risk of social exclusion, such as drug users, alcoholics, and economic immigrants [1,2,3,4]. Interest in TB recurrences has been growing because, despite efforts to control the disease globally, long-term cure is not maintained in all successfully treated patients [5,6]. Tuberculosis recurrence can be defined as a new episode occurring in adequately treated patients who completed therapy [8]. Both the Centers for Disease Control and the Instituto de Salud Carlos III (ISCIII) accept that all TB episodes occurring 1 year or later after treatment completion in patients who were disease-free should be considered as new TB cases and as recurrences [9,10]. Patients with a history of tuberculosis (TB) have a high probability of recurrence because long-term cure is not always maintained in successfully treated patients. The aim of this study was to identify the probability of TB recurrence and its predictive factors in a cohort of socially vulnerable patients who completed treatment in the TB referral center in Catalonia, which acts as the center for patients with social and health problems
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