Rates of drug resistance and risk factor analysis in civilian and prison patients with tuberculosis in Samara Region, Russia
Rates of drug resistance and risk factor analysis in civilian and prison patients with tuberculosis in Samara Region, Russia
复制标题
DOI：
10.1136/thx.2004.026922
复制
发表时间：
2005-02-01
期刊：
影响因子：
10
通讯作者：
Drobniewski, F
中科院分区：
文献类型：
--
作者：
Ruddy, M;Balabanova, Y;Drobniewski, F
背景：在俄罗斯，结核病（TB）和艾滋病毒感染率持续上升，但真正的耐药率，特别是耐多药结核病（MDR TB）的耐药率尚不清楚。进行了一项研究，目的是查明平民和监狱部门新出现和以前治疗过的病例的第一线耐药性；以及产生耐药性的风险因素。方法：对俄罗斯萨马拉州2001- 2002年间细菌学确诊肺结核的600例患者（309名平民，291名囚犯）进行了横断面调查。结果：平民和监狱结核病新发病例中异烟肼、利福平、链霉素、乙胺丁醇和吡嗪酰胺耐药率分别为38.0%、25.2%、34.6%、14.7%和7.2%。在所有新发病例、平民新发病例和监狱新发病例中，耐多药结核病的患病率分别为22.7%、19.8%和37.3%，在既往治疗病例中，总体患病率分别为45.5%和55.3%。与耐药相关的因素包括既往结核病治疗4周以上、吸烟（因异烟肼耐药）、胸片上出现空泡和监禁。在所有患者中，HIV与耐药性并不相关。囚犯的耐药率明显更高，耐多药结核病的耐药率比（RR）为1.9 (95% CI 1.1至3.2)，利福平的耐药率比为1.9 (95% CI 1.1至3.2)，异烟肼的耐药率比为1.6 （95% CI 1.0至2.6）。结论：一线耐药率很高，特别是在囚犯和以前治疗过的病例中。结核病控制规划最初应侧重于标准化治疗，以最大限度地提高治愈率，同时采取措施减少结核病机构传播（特别是在监狱中），同时对耐多药结核病进行早期诊断，以减少结核病的传播和耐药性的发展。
Background: Tuberculosis (TB) and HIV rates continue to escalate in Russia, but true rates for drug resistance, especially multidrug resistant tuberculosis (MDR TB), are unknown. A study was conducted with the aims of identifying first line drug resistance, both in the civilian and prison sectors, for new and previously treated cases; and risk factors for the development of drug resistance.Methods: A cross sectional survey was undertaken of 600 patients (309 civilians, 291 prisoners) with bacteriologically confirmed pulmonary TB over a 1 year period during 2001-2 in Samara Oblast, Russia.Results: The prevalence of isoniazid, rifampicin, streptomycin, ethambutol and pyrazinamide resistance in new TB cases ( civilian and prison patients) was 38.0%, 25.2%, 34.6%, 14.7%, and 7.2%, respectively. The prevalence of MDR TB was 22.7%, 19.8%, and 37.3% in all new cases, new civilian cases, and new prison cases, respectively, with an overall prevalence of 45.5% and 55.3% in previously treated cases. Factors associated with resistance included previous TB treatment for more than 4 weeks, smoking (for isoniazid resistance), the presence of cavitations on the chest radiograph, and imprisonment. HIV was not associated with resistance in all patients. The rates of resistance were significantly higher in prisoners, with rate ratios (RR) of 1.9 (95% CI 1.1 to 3.2) for MDR TB, 1.9 (95% CI 1.1 to 3.2) for rifampicin, and 1.6 (95% CI 1.0 to 2.6) for isoniazid.Conclusions: Rates of first line drug resistance are high, particularly in prisoners and previously treated cases. TB control programmes should initially focus on standardised treatment to maximise cure, combined with measures to reduce institutional TB spread ( particularly in prisons) coupled with early diagnosis of MDR TB to reduce the spread and development of resistance.