Risk factors for recurrent Mycobacterium ulcerans disease after exclusive surgical treatment in an Australian cohort

O'Brien, Daniel P., Walton, Aaron, Hughes, Andrew J., Friedman, N. Deborah, McDonald, Anthony, Callan, Peter, Rahdon, Richard, Holten, Ian and Athan, Eugene 2013, Risk factors for recurrent Mycobacterium ulcerans disease after exclusive surgical treatment in an Australian cohort, Medical journal of Australia, vol. 198, no. 8, pp. 436-439.

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Title Risk factors for recurrent Mycobacterium ulcerans disease after exclusive surgical treatment in an Australian cohort
Author(s) O'Brien, Daniel P.
Walton, Aaron
Hughes, Andrew J.
Friedman, N. Deborah
McDonald, Anthony
Callan, Peter
Rahdon, Richard
Holten, Ian
Athan, Eugene
Journal name Medical journal of Australia
Volume number 198
Issue number 8
Start page 436
End page 439
Total pages 4
Publisher Australasian Medical Publishing
Place of publication Sydney, N. S. W.
Publication date 2013-05
ISSN 0025-729X
Keyword(s) mycobacterium ulcerans
recurrence
infection
surgery
risk factors
treatment
Summary Objective: To describe risk factors for recurrence after exclusive surgical treatment of Mycobacterium ulcerans infection. Design, setting and participants: Prospective observational cohort study of all M. ulcerans cases managed with surgery alone at Barwon Health, a tertiary referral hospital, from 1 January 1998 to 31 December 2011. A random-effects Poisson regression model was used to assess rates and associations of treatment failure. Main outcome measures: Rates of treatment failure and rate ratios (RRs) for factors associated with treatment failure. Results: Of 192 patients with M. ulcerans infection, 50 (26%) had exclusive surgical treatment. Median age was 65.0 years (interquartile range [IQR], 45.5-77.7 years), and median duration of symptoms was 46 days (IQR, 26-90 days). There were 20 recurrences in 16 patients. For first lesions, the recurrence incidence rate was 41.8 (95% CI, 25.6-68.2) per 100 person-years, and median time to recurrence was 50 days (IQR, 30-171 days). Recurrence occurred ≤ 3 cm from the original lesion in 13 cases, and >3 cm in nine. On univariable analysis, age ≥60 years (RR 13.84; 95% CI, 2.21-86.68; P< 0.01), distal lesions (RR, 20.43; 95% CI, 1.97-212.22; P<0.01), positive histological margins (RR, 21.02; 95% CI, 5.51-80.26; P< 0.001), immunosuppression (RR, 17.97; 95% CI, 4.17-77.47; P <0.01) and duration of symptoms >75 days (RR, 10.13; 95% CI, 1.76-58.23; P =0.02) were associated with treatment failure. On multivariable analysis, positive margins (RR, 7.72; 95% CI, 2.71-22.01; P<0.001) and immunosuppression (RR, 6.45; 95% CI, 2.42-17.20; P =0.01) remained associated with treatment failure. Conclusions: Recurrence rates after exclusive surgical treatment of M. ulcerans disease in an Australian cohort are high, with increased rates associated with immunosuppression or positive histological margins.

Language eng
Field of Research 110309 Infectious Diseases
Socio Economic Objective 920109 Infectious Diseases
HERDC Research category C1 Refereed article in a scholarly journal
Persistent URL http://hdl.handle.net/10536/DRO/DU:30054645

Document type: Journal Article
Collection: School of Medicine
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Created: Fri, 26 Jul 2013, 15:04:29 EST by Barb Lavelle

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