Multidrug-resistant and extensively drug-resistant tuberculosis: a threat to global control of tuberculosis
Multidrug-resistant and extensively drug-resistant tuberculosis: a threat to global control of tuberculosis
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DOI：
10.1016/s0140-6736(10)60410-2
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发表时间：
2010-05-22
期刊：
影响因子：
168.9
通讯作者：
Bayona, Jaime
中科院分区：
文献类型：
--
作者：
Gandhi, Neel R.;Nunn, Paul;Bayona, Jaime
尽管在减少全球对药物敏感的结核病发病率方面取得了进展，但过去十年出现的多药耐药(MDR)和广泛耐药(XDR)结核病可能会破坏这些进展。然而，各国的反应太慢了。在2008年发生的约440000例耐多药结核病病例中，只有7%被确认并报告给世卫组织。在这些病例中，只有五分之一得到了世卫组织标准的治疗。尽管目前可用的诊断技术和药物可以治疗耐多药和广泛耐药结核病，但与药物敏感的结核病相比，治疗过程要昂贵和费力得多，治疗失败率和死亡率都更高。尽管如此，有几个国家提供了如何利用现有技术在十年内扭转耐多药结核病流行的例子。将需要在实验室能力、感染控制、结核病控制方案的执行以及针对药物敏感和耐药疾病的治疗方案方面进行重大改进，同时大规模扩大耐多药结核病和广泛耐药结核病的诊断和治疗，以防止耐药菌株成为结核病的主要形式。新的诊断测试和药物很可能在未来几年内出现，并应加快耐多药和广泛耐药结核病的控制。同样重要的是，特别是在负担最重的印度、中国和俄罗斯等国家，将致力于结核病控制，包括改进国家政策和卫生系统，消除治疗的财务障碍，鼓励合理用药，并创建在全国范围内管理耐多药结核病所需的基础设施。
Although progress has been made to reduce global incidence of drug-susceptible tuberculosis, the emergence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis during the past decade threatens to undermine these advances. However, countries are responding far too slowly. Of the estimated 440000 cases of MDR tuberculosis that occurred in 2008, only 7% were identified and reported to WHO. Of these cases, only a fifth were treated according to WHO standards. Although treatment of MDR and XDR tuberculosis is possible with currently available diagnostic techniques and drugs, the treatment course is substantially more costly and laborious than for drug-susceptible tuberculosis, with higher rates of treatment failure and mortality. Nonetheless, a few countries provide examples of how existing technologies can be used to reverse the epidemic of MDR tuberculosis within a decade. Major improvements in laboratory capacity, infection control, performance of tuberculosis control programmes, and treatment regimens for both drug-susceptible and drug-resistant disease will be needed, together with a massive scale-up in diagnosis and treatment of MDR and XDR tuberculosis to prevent drug-resistant strains from becoming the dominant form of tuberculosis. New diagnostic tests and drugs are likely to become available during the next few years and should accelerate control of MDR and XDR tuberculosis. Equally important, especially in the highest-burden countries of India, China, and Russia, will be a commitment to tuberculosis control including improvements in national policies and health systems that remove financial barriers to treatment, encourage rational drug use, and create the infrastructure necessary to manage MDR tuberculosis on a national scale.