Clinical consequences and transmissibility of drug-resistant tuberculosis in southern Mexico
Clinical consequences and transmissibility of drug-resistant tuberculosis in southern Mexico
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DOI：
10.1001/archinte.160.5.630
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发表时间：
2000-03-13
影响因子：
--
通讯作者：
Small, PM
中科院分区：
文献类型：
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作者：
García-García, MD;Ponce-de-León, A;Small, PM
背景资料：耐药结核病（TB）在发展中国家使用直接观察治疗，短期（DOTS）的后果，没有很好地defined.Objective：确定耐药的临床结果和结核病的传播programmalconditions.Patients和方法的影响：在墨西哥南部进行了前瞻性队列和分子流行病学研究。在1995年3月至1998年2月期间，所有持续性咳嗽的患者，其支气管中有抗酸杆菌（AFB），均接受了临床和真菌学评价（菌种鉴定、药物敏感性试验和基于IS 6110的基因分型）。根据墨西哥国家结核病方案提供治疗。临床和微生物学的结果和分子流行病学定义transmission.Results：结核分枝杆菌分离出238的284 AFB涂片阳性的人。总体耐药率为28.4%（新发20.7%，复治54.7%），10.8%（新发3.3%，复治35.8%）为多药耐药结核病，对异烟肼和利福平耐药。治疗后，75%（新，81.0%，复治，52.8%）治愈，8%（新，7.8%;复治，7.5%）放弃治疗，9%（新，3.9%;复治，28.3%）治疗失败，4%（新，3.3%;复治，7.5%）死亡。另有2%的患者复发，9%的患者在中位24.4个月的随访期间死亡。耐药是治疗失败的一个重要独立危险因素。感染多药耐药结核病是唯一的因素与一个减少的可能性是在一个限制性片段长度多态性cluster.Conclusions：尽管使用DOTS，耐药结核病患者的治疗失败和死亡的概率显着增加。尽管耐多药结核病可能具有降低的传播和致病倾向，但它具有深刻的？对结核病控制产生负面影响。
Background: Consequences of drug-resistant tuberculosis (TB) in developing countries using directly observed treatment, short-course (DOTS), are not well defined.Objective: To determine the impact of drug resistance on clinical outcome and transmission of TB under programmatic conditions.Patients and Methods: A prospective cohort and molecular epidemiologic study was conducted in southern Mexico. Between March 1995 and February 1998 all patients with persistent cough whose sputa had acid-fast bacilli (AFB) underwent clinical and mycobaeteriologic evaluation (species identification, drug susceptibility testing,and IS6110-based genotyping). Treatment was provided in accordance with Mexico's National Tuberculosis Program. Clinical and microbiologic outcomes and molecular epidemiologically defined transmission were measured.Results: Mycobacterium tuberculosis was isolated from 238 of the 284 AFB smear-positive persons. The overall rate of resistance was 28.4% (new, 20.7%; retreated, 54.7%), and 10.8% (new, 3.3%; retreated, 35.8%) had multi-drug-resistant TB tie, resistance to isoniazid and rifampin). After treatment, 75% (new, 81.0%, retreated, 52.8%) were cured, 8% (new, 7.8%; retreated, 7.5%) abandoned therapy, 9% (new, 3.9%; retreated, 28.3%) had treatment failure, and 4% (new, 3.3%; retreated, 7.5%) died. Another 2% of patients relapsed, and 9% died during a median of 24.4 months of follow-up. Drug-resistance was a strong independent risk factor for treatment failure. Being infected with multi-drug-resistant TB was the only factor associated with a decreased Likelihood of being in a restriction fragment length polymorphism cluster.Conclusions: Despite the use of DOTS, patients with drug-resistant TB had a dramatically increased probability of treatment failure and death. Although multi-drug-resistant TB may have a decreased propensity to spread and cause disease, it has a profoundly? negative impact on TB control.