Few eligible for the newly recommended short course MDR-TB regimen at a large Mumbai private clinic
Few eligible for the newly recommended short course MDR-TB regimen at a large Mumbai private clinic
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DOI：
10.1186/s12879-019-3726-8
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发表时间：
2019-01-28
影响因子：
3.7
通讯作者：
Gupta, Amita
中科院分区：
文献类型：
--
作者：
Udwadia, Zarir F.;Tornheim, Jeffrey A.;Gupta, Amita
印度是世界上结核病负担最高的国家，孟买尤其受到耐多药结核病（MDR-TB）的影响。世卫组织建议对以前未经治疗的肺部耐多药结核病患者进行短期强化治疗（short Course），但不要求在短期治疗前进行普遍药敏试验。DST可能会在孟买等地筛查出许多耐多药结核病患者。方法招募一家私人诊所的smdr - tb患者进行前瞻性观察队列研究。根据临床标准和DST结果评估短期课程的资格。DST的合格性分为利福平单药耐药（采用Xpert MTB/RIF检测）、利福平、氟喹诺酮类药物、第二线注射药物耐药（采用线探针检测）和对其他药物耐药。结果559名耐多药结核病患者中，33%符合短期课程的临床资格。利福平、氟喹诺酮类药物和二线注射药物的DST排除了74.7%的参与者。完全表型DST排除了96.6%的参与者。先前使用一线或二线药物治疗对入选资格没有显著影响。结论在全球耐多药结核病热点地区，
BackgroundIndia has the world's highest tuberculosis burden, and Mumbai is particularly affected by multidrug resistant tuberculosis (MDR-TB). WHO recommends short, intensive treatment (Short Course) for previously untreated pulmonary MDR-TB patients but does not require universal drug susceptibility testing (DST) before Short Course. DST would likely screen out many MDR-TB patients in places like Mumbai with significant drug resistance.MethodsMDR-TB patients at a private clinic were recruited for a prospective observational cohort. Short Course eligibility was evaluated by clinical criteria and DST results. Eligibility by DST was classified as rifampin monoresistance (as tested by Xpert MTB/RIF), rifampin, fluoroquinolones, and 2nd-line injectable drugs resistance (as tested by line probe assays) and resistance to other drugs.ResultsOf 559 participants with MDR-TB, 33% met clinical eligibility for Short Course. DST for rifampin, fluoroquinolones, and 2nd-line injectable drugs excluded 74.7% of participants. Complete phenotypic DST excluded 96.6% of participants. Prior treatment with either 1st or 2nd-line drugs did not significantly affect eligibility.ConclusionsIn a global MDR-TB hotspot,