Objective To study the efficacy and safety of combined anti-tuberculosis regimen containing bedaquiline in the treatment of multidrug-resistant tuberculosis (MDR-TB). Methods A total of 69 MDR-TB patients treated by joint regimen combined bedaquiline with other anti-tuberculosis drugs between March 2018 and August 2019 in Public Health Clinical Center of Chengdu were taken as the trial group, and 60 MDR-TB patients received treatment without bedaquiline between June 2016 and December 2017 in the same hospital were taken as the control group. The efficacy and safety of the two groups were compared. Results The 69 patients in the trial group included 44 males and 25 females, aged from 21 to 63 years, with an average of (34.6±11.0) years; 58 patients (84.1%) completed the 24-week treatment with bedaquiline, while 11 patients did not complete the treatment, including 3 deaths (4.3%), 1 loss of follow-up (1.4%), 1 withdrawal from the study (1.4%), and 6 discontinuation due to adverse events (8.7%). Among the 54 patients with positive results of tuberculosis on baseline sputum culture, 49 transformed to negative results within 24 weeks of treatment (the negative conversion rate was 90.7%), and the median negative conversion time was 13.0 weeks. The 60 patients in the control group included 45 males and 15 females, aged from 16 to 66 years, with an average of (35.5±13.2) years. Among the 53 patients with positive results of tuberculosis on baseline sputum culture, 30 transformed to negative results within 24 weeks of treatment (the negative conversion rate was 56.6%), and the median negative conversion time was 12.0 weeks. The negative conversion rate of sputum bacteria in the trial group was significantly higher than that in the control group (χ2=16.133, P<0.001). The most common adverse reactions in the trial group were liver function abnormalities (42 cases, 60.9%), prolonged QTc interval (37 cases, 53.6%), electrolyte disturbances (20 cases, 29.0%), and blood system damage (20 cases, 29.0%). In the 37 patients who experienced prolonged QTc interval, there were 8 patients with QTc intervals≥500 ms and 29 patients with QTc intervals ≥450 ms and <500 ms, with a median occurrence time of 16.0 weeks, among whom 25 patients experienced prolonged QTc interval in 4-48 weeks after the withdrawal of bedaquiline. Conclusion The negative conversion rate of tuberculosis sputum culture of patients with MDR-TB treated by bedaquiline combined with other anti- tuberculosis drugs is high, but electrocardiogram should be closely monitored during and after the treatment in order to guard against the potential cardiac toxic effects of bedaquiline.
Objective The current study aimed to compare the differences in clinical characteristics and prognosis of elderly patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection between patients who were vaccinated and those not and to explore the clinical significance of vaccination for the elderly.Methods A total of 92 elderly patients (≥60 years old) with SARS-CoV-2 infection who were admitted to Chengdu Public Health Clinical Center from December 10, 2020, to May 2, 2022, were included, and they were grouped according to whether vaccinated. The differences in clinical manifestations, laboratory examinations, imaging, treatment, prognosis, hospitalization time, and nucleic acid conversion time between the two groups were compared in this study. Results A total of 92 elderly patients were included, with a male-to-female ratio of 1.3:1, and a median age of 66 (62, 71) years old. There were 79 patients in the vaccinated group and 13 in the unvaccinated group. The positive rate of total SARS-CoV-2 antibody in 92 patients was 91.3%, and those of IgG and IgM of SARS-CoV-2 antibody were 89.1% and 37%, respectively. The positive rates of total SARS-CoV-2 antibody and IgG of SARS-CoV-2 antibody in the vaccinated group were higher than those in the unvaccinated group (97.5% vs. 53.8%, 96.2% vs. 46.2%) (P<0.01), and COI values of total antibody, IgM and IgG were higher than those of unvaccinated group (P<0.01). The proportions of the initial symptoms of sputum, ground-glass opacity or patchy opacity involving both lungs in chest CT in the unvaccinated group were higher than those in the vaccinated group (P<0.05). The white blood cell counts and platelet counts in the vaccinated group were higher than those in the unvaccinated group, whereas the prothrombin time and D-dimer were lower than those in the unvaccinated group (P<0.05). COI values of total antibody in the 3-doses group were higher than those in the 2-doses group, and the white blood cell counts in the 3-doses group were higher than those in the 2-doses group (all P<0.05). During hospitalization, asymptomatic infection (58.2%) and general type (53.8%) was the most common in the vaccinated and unvaccinated group, respectively. Patients in the unvaccinated group were more likely to progress to severe status than the vaccinated group during hospitalization (15.4% vs. 0%, P=0.019). The unvaccinated group received more treatments of intravenous immune globulin, non-invasive and invasive mechanical ventilation, plasma after immunization of vaccine and convalescent plasma of SARS-CoV-2 infected patients than those of the vaccinated group (P<0.05). Patients in the unvaccinated group developed a higher proportion of respiratory failure, secondary infection, acute respiratory distress syndrome, and heart failure than in the vaccinated group (P< 0.05). The median lengths of hospitalization and nucleic acid conversion in the unvaccinated group were 22 (7, 32) days and 13 (2, 20) days, which were longer than those in the vaccinated group [8 (7, 12) days, 2 (2, 7) days] (all P<0.05). Conclusions Vaccination of SARS-CoV-2 can improve the positive rate of total SARS-CoV-2 antibody and IgG of SARS-CoV-2 antibody in elderly patients with SARS-CoV-2 infection, milder disease status, and can shorten the time of hospitalization and nucleic acid conversion. These results suggest that the COVID-19 vaccine can reduce the disease and improve the prognosis in the elderly.