Impact of extensive drug resistance on treatment outcomes in non-HIV-infected patients with multidrug-resistant tuberculosis
Impact of extensive drug resistance on treatment outcomes in non-HIV-infected patients with multidrug-resistant tuberculosis
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DOI：
10.1086/522537
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发表时间：
2007-11-15
影响因子：
11.8
通讯作者：
Yim, Jae-Joon
中科院分区：
文献类型：
--
作者：
Kim, Hye-Ryoun;Hwang, Seung Sik;Yim, Jae-Joon
背景最近，广泛耐药结核病引起了人们的严重关注，这种结核病除异烟肼和利福平外，还对二线抗结核药物产生耐药性。本研究旨在阐明非人类免疫缺陷病毒（HIV）感染的耐多药结核病（MDR-TB）患者广泛耐药对治疗结果的影响。纳入了1996年1月至2005年12月期间在首尔国立大学医院（首尔，大韩民国）接受耐多药结核诊断和治疗的患者。广泛耐药结核病的定义是由对异烟肼和利福平均表现出耐药性的杆菌引起的结核病，并且还表现出对任何氟喹诺酮和以下3种可注射抗结核药物中的至少一种的耐药性：卷曲霉素、卡那霉素和阿米卡星。为了明确广泛耐药对治疗结果的影响，进行单因素比较和多元Logistic回归分析。共有211名非艾滋病毒感染的耐多药结核病患者被纳入最终分析。其中，43例患者（20.4%）患有广泛耐药结核病。在19例（44.2%）广泛耐药结核患者中观察到治疗失败，而46例（27.4%）非广泛耐药结核患者治疗失败（P = 0.057）。广泛耐药（校正比值比[OR]，4.46; 95%置信区间[CI]，1.35 - 14.74）和基础合并症（校正OR，2.62; 95% CI，1.00-6.87）的存在是治疗失败的独立风险因素。然而，较高水平的白蛋白与治疗失败呈负相关（调整后的OR，0.87; 95%CI，0.77-0.97）。结论。在非HIV感染的MDR-TB患者中，广泛耐药、合并症和低白蛋白血症是独立的不良预后因素。
Background. Recently, serious concerns about extensively drug-resistant tuberculosis (XDR-TB), which shows resistance to second-line anti-TB drugs in addition to isoniazid and rifampicin, have been raised. The aim of this study was to elucidate the impact of extensive drug resistance on treatment outcomes in non-human immunodeficiency virus (HIV)-infected patients with multidrug-resistant tuberculosis (MDR-TB).Methods. Patients who received the diagnosis of and treatment as having MDR-TB at Seoul National University Hospital (Seoul, Republic of Korea) between January 1996 and December 2005 were included. The definition of XDR-TB was TB caused by bacilli showing resistance to both isoniazid and rifampicin and also showing resistance to any fluoroquinolone and to at least 1 of the following 3 injectable anti-TB drugs: capreomycin, kanamycin, and amikacin. To identify the impact of extensive drug resistance on treatment outcomes, univariate comparison and multiple logistic regression were performed.Results. A total of 211 non -HIV-infected patients with MDR-TB were included in the final analysis. Among them, 43 patients (20.4%) had XDR-TB. Treatment failure was observed in 19 patients (44.2%) with XDR-TB, whereas treatment of 46 patients (27.4%) with non-XDR-TB failed (P = .057). The presence of extensive drug resistance ( adjusted odds ratio [OR], 4.46; 95% confidence interval [CI], 1.35 - 14.74) and underlying comorbidity ( adjusted OR, 2.62; 95% CI, 1.00-6.87) were independent risk factors for treatment failure. However, a higher level of albumin was inversely associated with treatment failure (adjusted OR, 0.87; 95% CI, 0.77-0.97).Conclusion. The presence of extensive drug resistance, the presence of comorbidity, and hypoalbuminemia were independent poor prognostic factors in non - HIV-infected patients with MDR-TB.