Characteristics of drug-resistant tuberculosis in Abkhazia (Georgia), a high-prevalence area in Eastern Europe
Characteristics of drug-resistant tuberculosis in Abkhazia (Georgia), a high-prevalence area in Eastern Europe
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DOI：
10.1016/j.tube.2009.04.002
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发表时间：
2009-07-01
期刊：
影响因子：
3.2
通讯作者：
Bonnet, Maryline
中科院分区：
文献类型：
--
作者：
Pardini, Manuela;Niemann, Stefan;Bonnet, Maryline
虽然耐多药结核病是东欧的一个主要公共卫生问题，但导致耐多药结核病出现、传播和遏制的因素尚未得到很好的界定。在此，我们分析了2003年至2005年在阿布哈兹（格鲁吉亚）进行的一项横断面研究中耐药结核病的特征，在该研究中，标准短程化疗辅以个体化耐药治疗。对来自连续涂阳肺结核患者的结核分枝杆菌复合群菌株进行药物敏感试验（DST）和分子分型。在366名患者中，60.4%对任何一线药物都有耐药性，21%患有耐多药结核病。总体而言，所有菌株中有25%属于北京基因型，发现其与耐多药结核病风险（OR 25.9，95% CI 10.2-66.0）和传播风险（OR 2.8，95% CI 1.6-5.0）密切相关。一个占主导地位的耐多药结核病北京克隆占所有耐多药结核病病例的23%。MDR-TB的水平在研究期间没有下降，与先前治疗的病例中MDR北京菌株的水平增加相一致。鉴于“高传播性”MDR北京菌株在社区中的传播，标准化疗加上由常规DST指导的个体化耐药治疗可能不足以控制东欧的MDR-TB。(C)2009爱思唯尔有限公司保留所有权利。
Although multidrug-resistant (MDR) tuberculosis (TB) is a major public health problem in Eastern Europe, the factors contributing to emergence, spread and containment of MDR-TB are not well defined. Here, we analysed the characteristics of drug-resistant TB in a cross-sectional study in Abkhazia (Georgia) between 2003 and 2005, where standard short-course chemotherapy is supplemented with individualized drug-resistance therapy. Drug susceptibility testing (DST) and molecular typing were carried out for Mycobacterium tuberculosis complex strains from consecutive smear-positive TB patients. Out of 366 patients, 60.4% were resistant to any first-line drugs and 21% had MDR-TB. Overall, 25% of all strains belong to the Beijing genotype, which was found to be strongly associated with the risk of MDR-TB (OR 25.9, 95% CI 10.2-66.0) and transmission (OR 2.8, 95% CI 1.6-5.0). One dominant MDR Beijing clone represents 23% of all MDR-TB cases. The level of MDR-TB did not decline during the study period, coinciding with increasing levels of MDR Beijing strains among previously treated cases.Standard chemotherapy plus individualized drug-resistance therapy, guided by conventional DST, might be not sufficient to control MDR-TB in Eastern Europe in light of the spread of "highly transmissible" MDR Beijing strains circulating in the community. (C) 2009 Elsevier Ltd. All rights reserved.