Hospitalizations and Treatment Outcomes in Patients with Urogenital Tuberculosis in Tashkent, Uzbekistan, 2016–2018
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. General Setting
2.3. Specific Setting
2.4. Study Population and Period
2.5. Variables, Definitions, Data Sources
2.6. Data Entry and Analysis
3. Results
3.1. Patient Characteristics
3.2. Hospitalizations and Length of Stay
3.3. Factors Associated with Length of Stay
3.4. Treatment Outcomes
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Disclaimer
Open Access Statement
Abbreviations
BMI | body mass index |
CI | confidence interval |
DST | drug-susceptibility testing |
HI | human immunodeficiency virus |
IRR | incidence rate ratio calculated by negative binomial regression |
LOS | length of stay |
Q1 | 25th percentile |
Q3 | 75th percentile |
ref. | reference category |
TB | tuberculosis |
UGTB | urogenital tuberculosis |
Appendix A. Definition of Urogenital Tuberculosis Treatment Outcomes in Uzbekistan by the National Treatment Guidelines
Treatment Outcome | Description |
Cured | A patient with bacteriologically confirmed tuberculosis at the beginning of treatment who was urine smear- or culture-negative in the last month of treatment and on at least one previous occasion. |
Treatment completed | A tuberculosis patient who completed treatment without evidence of failure but with no record to show that urine smear or culture results in the last month of treatment and on at least one previous occasion were negative, either because tests were not done or because results are unavailable. A patient with clinically diagnosed tuberculosis who did not have clinical symptoms at the end of treatment, such as normalization of urine, blood tests, and X-ray of the urinary tract. |
Treatment failed | A patient with bacteriologically confirmed tuberculosis at the beginning of treatment whose urine smear or culture was positive at month 5 or later during treatment. A patient with clinically diagnosed tuberculosis who had deterioration of urine tests, blood tests, or X-ray of the urinary tract at month 5 or later during treatment. |
Died | A tuberculosis patient who died for any reason before starting or during the course of treatment. |
Lost to follow-up | A tuberculosis patient who did not start treatment or whose treatment was interrupted for 2 consecutive months or more. |
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Characteristics/Variables | N | (%) | |
---|---|---|---|
Total | 142 | (100) | |
Age, mean (SD) categories | Mean (SD, min–max) | 40 (16, 18–80) | |
18–34 | 67 | (47) | |
35–54 | 45 | (32) | |
55–80 | 30 | (21) | |
Sex | Male | 77 | (54) |
Female | 65 | (46) | |
Type of residence | Urban | 29 | (20) |
Rural | 113 | (80) | |
Alcohol abuse | Yes | 3 | (2) |
No/Not recorded | 139 | (98) | |
Current tobacco smoking | Yes | 30 | (21) |
No/Not recorded | 112 | (79) | |
Labor migration to other countries in the past six months | Yes | 7 | (5) |
No/Not recorded | 135 | (95) | |
Bacteriological confirmation | Clinically diagnosed | 74 | (52) |
Laboratory confirmed | 68 | (48) | |
Urine microscopy at admission | M. tb detected | 9 | (6) |
M. tb not detected | 133 | (94) | |
Xpert MTB/RIF at admission | Rifampicin sensitive | 56 | (39) |
M. tb not detected | 84 | (59) | |
Not recorded | 2 | (2) | |
Culture at admission | M. tb detected | 30 | (21) |
M. tb not detected | 111 | (78) | |
Contamination | 1 | (1) | |
Disseminated TB | No | 118 | (83) |
Yes | 23 | (16) | |
Not recorded | 1 | (1) | |
Type of UGTB | Urinary tract TB | 87 | (61) |
Genital TB | 14 | (10) | |
Both | 41 | (29) | |
Previous history of TB | Pulmonary | 6 | (4) |
Extrapulmonary (except UGTB) | 3 | (2) | |
None | 131 | (92) | |
Not recorded | 2 | (1) | |
BMI at admission | <18.5 | 15 | (11) |
18.5–24.9 | 118 | (83) | |
25.0–29.9 | 6 | (4) | |
30.0–39.9 | 3 | (2) | |
Comorbidities | Hypertension | 33 | (23) |
Diabetes mellitus | 11 | (8) | |
Anemia | 33 | (23) | |
Hepatitis B | 4 | (3) | |
Hepatitis C | 2 | (1) | |
HIV status | 3 | (2) | |
Non-specific urinary tract infection | 63 | (44) | |
Other 1 | 43 | (30) | |
Any comorbidity | 90 | (66) | |
Surgery for UGTB | None | 93 | (65) |
During intensive phase | 45 | (32) | |
During continuation phase | 2 | (1) | |
During both phases | 2 | (1) | |
Serious adverse events during treatment | Reported | 8 | (6) |
Not reported | 134 | (94) |
Median LOS | Unadjusted | Adjusted | |||
---|---|---|---|---|---|
(Q1; Q2) | IRR (95% CI) | p | IRR (95% CI) | p | |
Age groups, years | |||||
18–34 | 56 (56; 58) | ref. | ref. | ||
35–54 | 56 (56; 57) | 1.05 (0.86; 1.28) | 0.63 | 0.92 (0.77; 1.09) | 0.31 |
55–80 | 57 (55; 70) | 0.94 (0.75; 1.18) | 0.56 | 0.93 (0.74; 1.17) | 0.56 |
Sex | |||||
Male | 56 (56; 57) | ref. | ref. | ||
Female | 56 (56; 58) | 0.95 (0.80; 1.13) | 0.55 | 0.95 (0.82; 1.1) | 0.49 |
Type of residence | |||||
Urban | 57 (55; 70) | ref. | - | - | |
Rural | 56 (56; 57) | 1.00 (0.81; 1.24) | 0.99 | - | - |
Alcohol abuse at admission | |||||
No | 56 (56; 58) | ref. | ref. | ||
Yes | 56 (56; 105) | 1.16 (0.67; 2.23) | 0.62 | 2.01 (0.99; 4.21) | 0.06 |
Current tobacco smoking at admission | |||||
No | 56 (56; 58) | ref. | - | - | |
Yes | 56 (55; 57) | 0.97 (0.79; 1.20) | 0.78 | - | - |
Labor migration to other countries in the past 6 months prior to admission | |||||
No | 56 (56; 58) | ref. | ref. | ||
Yes | 56 (0; 56) | 0.63 (0.43; 0.95) | 0.02 | 0.46 (0.32; 0.69) | <0.001 |
UGTB diagnosis | |||||
Clinically diagnosed | 56 (56; 58) | ref. | ref. | ||
Laboratory confirmed | 56 (55; 59) | 1.08 (0.91; 1.28) | 0.40 | 1.07 (0.92; 1.25) | 0.34 |
Disseminated TB | |||||
No | 56 (56; 57) | ref. | - | - | |
Yes | 56 (55; 76) | 1.00 (0.79; 1.27) | 0.98 | - | - |
Type of UGTB | |||||
Urinary tract and genital TB | 56 (56; 58) | ref. | |||
Urinary tract TB only | 56 (56; 58) | 1.02 (0.84; 1.24) | 0.82 | - | - |
Genital TB only | 56 (55; 57) | 0.85 (0.63; 1.18) | 0.33 | - | - |
Previous history of pulmonary or extrapulmonary TB, except UGTB | |||||
No | 56 (56; 57) | ref. | - | - | |
Yes | 70 (56; 84) | 1.13 (0.81; 1.65) | 0.49 | - | - |
BMI | |||||
<18.5 | 57 (56; 67) | ref. | - | - | |
18.5–24.9 | 56 (56; 58) | 1.08 (0.8; 1.41) | 0.61 | - | - |
>24.9 | 56 (55; 56) | 0.87 (0.57; 1.36) | 0.54 | - | - |
Hypertension | |||||
No | 56 (56; 58) | ref. | ref. | ||
Yes | 57 (55; 67) | 1.10 (0.90; 1.36) | 0.34 | 1.12 (0.91; 1.4) | 0.29 |
Diabetes Mellitus | |||||
No | 56 (56; 58) | ref. | ref. | ||
Yes | 55 (54; 57) | 0.86 (0.63; 1.20) | 0.35 | 0.79 (0.57; 1.09) | 0.15 |
Anemia | |||||
No | 56 (56; 58) | ref. | - | - | |
Yes | 56 (55; 57) | 0.97 (0.80; 1.20) | 0.80 | - | - |
Hepatitis B | |||||
No | 56 (56; 57) | ref. | ref. | ||
Yes | 125 (85; 248) | 2.80 (1.82; 4.57) | <0.001 | 3.18 (1.98; 5.39) | <0.001 |
Hepatitis C (ref. no) | |||||
No | 56 (56; 58) | ref. | - | - | |
Yes | 81 (56; 105) | 1.29 (0.67; 2.92) | 0.49 | - | - |
HIV status | |||||
Negative | 56 (56; 58) | ref. | ref. | ||
Positive | 105 (56; 113) | 1.48 (0.86; 2.82) | 0.19 | 0.53 (0.25; 1.14) | 0.12 |
Non-specific urinary tract infection | |||||
No | 56 (56; 58) | ref. | - | - | |
Yes | 56 (55; 58) | 1.02 (0.86; 1.22) | 0.80 | - | - |
Surgery during treatment | |||||
No | 56 (55; 57) | ref. | ref. | ||
Yes | 57 (56; 85) | 1.15 (0.96; 1.37) | 0.14 | 1.18 (1.01; 1.38) | 0.045 |
Serious adverse events during treatment | |||||
No | 56 (56; 58) | ref. | - | - | |
Yes | 56 (55; 71) | 1.02 (0.72; 1.51) | 0.91 | - | - |
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Ismatov, B.; Sereda, Y.; Sahakyan, S.; Gadoev, J.; Parpieva, N. Hospitalizations and Treatment Outcomes in Patients with Urogenital Tuberculosis in Tashkent, Uzbekistan, 2016–2018. Int. J. Environ. Res. Public Health 2021, 18, 4817. https://doi.org/10.3390/ijerph18094817
Ismatov B, Sereda Y, Sahakyan S, Gadoev J, Parpieva N. Hospitalizations and Treatment Outcomes in Patients with Urogenital Tuberculosis in Tashkent, Uzbekistan, 2016–2018. International Journal of Environmental Research and Public Health. 2021; 18(9):4817. https://doi.org/10.3390/ijerph18094817
Chicago/Turabian StyleIsmatov, Bakhtiyor, Yuliia Sereda, Serine Sahakyan, Jamshid Gadoev, and Nargiza Parpieva. 2021. "Hospitalizations and Treatment Outcomes in Patients with Urogenital Tuberculosis in Tashkent, Uzbekistan, 2016–2018" International Journal of Environmental Research and Public Health 18, no. 9: 4817. https://doi.org/10.3390/ijerph18094817