Transmission of MDR and XDR tuberculosis in Shanghai, China.
Transmission of MDR and XDR tuberculosis in Shanghai, China.
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DOI：
10.1371/journal.pone.0004370
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发表时间：
2009
期刊：
影响因子：
3.7
通讯作者：
Gao Q
中科院分区：
文献类型：
--
作者：
Zhao M;Li X;Xu P;Shen X;Gui X;Wang L;Deriemer K;Mei J;Gao Q
多药耐药（MDR）和广泛耐药（XDR）结核病（TB）是全球性的健康问题。我们试图确定耐多药结核病和广泛耐药结核病在亚洲最大的城市之一上海的特征、患病率和传播的相对频率。在中国上海，结核病在地区结核病医院得到诊断。对所有培养阳性的结核病例进行一线药物的药敏试验，对MDR病例进行二线药物的试验。使用VNTR-7和VNTR-16对菌株进行基因分型，并确定每位患者的既往治疗史和治疗结果。2004年3月至2007年11月期间，有4 379例培养阳性结核病病例经药物敏感性检测结果确诊。247例（5.6%）感染了M.结核病和11例（6.3%）的175耐药患者的分离株进行了测试，二线药物的敏感性，是XDR。超过一半的MDR和XDR患者是新诊断的，既往没有结核病治疗史。近57%的MDR患者成功治疗。MDR和XDR菌株在上海地区的传播是一个严重的问题。虽然既往抗结核治疗史表明哪些个体可能已获得MDR或XDR TB，但它不能准确预测哪些TB患者患有由MDR和XDR菌株传播引起的疾病。因此，建议对新发和复治结核病例进行普遍的药物敏感性检测。
Multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) are global health problems. We sought to determine the characteristics, prevalence, and relative frequency of transmission of MDR and XDR TB in Shanghai, one of the largest cities in Asia. TB is diagnosed in district TB hospitals in Shanghai, China. Drug susceptibility testing for first-line drugs was performed for all culture positive TB cases, and tests for second-line drugs were performed for MDR cases. VNTR-7 and VNTR-16 were used to genotype the strains, and prior treatment history and treatment outcomes were determined for each patient. There were 4,379 culture positive TB cases diagnosed with drug susceptibility test results available during March 2004 through November 2007. 247 (5.6%) were infected with a MDR strain of M. tuberculosis and 11 (6.3%) of the 175 MDR patients whose isolate was tested for susceptibility to second-line drugs, were XDR. More than half of the patients with MDR and XDR were newly diagnosed and had no prior history of TB treatment. Nearly 57% of the patients with MDR were successfully treated. Transmission of MDR and XDR strains is a serious problem in Shanghai. While a history of prior anti-TB treatment indicates which individuals may have acquired MDR or XDR TB, it does not accurately predict which TB patients have disease caused by transmission of MDR and XDR strains. Therefore, universal drug susceptibility testing is recommended for new and retreatment TB cases.
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