Cape Town - A shortage of beds may be forcing hospitals to discharge patients with extensively drug-resistant tuberculosis (XDR-TB) before they are cured, and a minority may be unwittingly infecting others.
According to new research by Cape Town and Stellenbosch universities and Emory University School of Medicine in the US published in The Lancet on January 17, the research followed 107 XDR-TB patients from three hospitals in Cape Town, Upington and Johannesburg for five years.
During the course of the study, about 40 percent of the patients were eventually discharged.
However, researchers found that of those who had been discharged, about 40 percent were not cured at the time they were sent home and about a third of these patients were at a high risk of transmitting the disease.
The study is the first to suggest that South African hospitals may be discharging more XDR-TB patients before they are fully cured than previously thought, according to Keertan Dheda, a professor in UCT’s Department of Medicine.
“Alarmingly, we have shown for the first time… treatment failure, and discharge of such patients into the wider community, is occurring systematically on a countrywide level in South Africa,” said Dheda, who added that many hospitals feel pressure to discharge patients due to the scarce number of beds available.
“We think (these findings) are a mirror of what is happening on a wider scale.”
Dheda and his team also recorded at least one instance in which a patient had transmitted the diseases to a relative. The patient and his brother both eventually died, as did almost two-thirds of all patients enrolled in the study.
XDR-TB is resistant to both of the most commonly used anti-TB drugs, isoniazid and rifampin, and at least one second-line drug. However, some doctors have cautioned that discharged XDR-TB patients are not the source of South Africa’s large XDR-TB problem.
Dr Gilles van Cutsem is the South African medical co-ordinator for international humanitarian organisation Médecins sans Frontières. He says that people are much more likely to contract XDR-TB from people who have not been diagnosed and started treatment than they are from those who have been discharged from hospitals.
“Yes, some people are getting infected by people who have been discharged or are failing treatment, but the majority of transmission doesn’t happen like that,” Van Cutsem says.
What is clear from Dheda’s research is that the government’s 2012 decision to decentralise the treatment of multidrug-resistant TB (MDR-TB) has been a step in the right direction. While resistant to fewer treatments than XDR-TB, MDR-TB is also resistant to isoniazid and rifampin.
“MDR-TB has been officially decentralised…that makes treatment much more accessible,” Dheda added. - Health-e News Service