Treatment of extensively drug-resistant tuberculosis in Tomsk, Russia: a retrospective cohort study
Treatment of extensively drug-resistant tuberculosis in Tomsk, Russia: a retrospective cohort study
复制标题
DOI：
10.1016/s0140-6736(08)61204-0
复制
发表时间：
2008-10-18
期刊：
影响因子：
168.9
通讯作者：
Shin, Sonya S.
中科院分区：
文献类型：
--
作者：
Keshavjee, Salmaan;Gelmanova, Irina Y.;Shin, Sonya S.
背景结核分枝杆菌菌株导致无法治愈的耐药疾病是世界范围内的威胁。我们描述了广泛耐药结核病患者的治疗，管理和结果在托木斯克，Russian.Methods我们进行了一项回顾性队列研究，608例多重耐药结核病谁在平民或监狱服务的治疗，2000年9月10日至2004年11月1日，根据世界卫生组织建议的治疗策略。描述了广泛耐药（XDR）结核病和非广泛耐药（non-XDR）结核病患者的临床特征、管理实践和治疗结果。主要结果是频率差，有利的结果在治疗结束时。结果608例多重耐药结核病，29例（4.8%）患者有基线XDR结核。治疗失败在XDR结核患者中比非XDR结核患者更常见（31% vs 8.5%，p=0.0008）。48.3%的XDR结核患者和66.7%的非XDR结核患者治疗治愈或完成（p=0.04）。XDR和非XDR tuberculo.Interpretation患者的不良事件的频率和管理没有差异这些患者的结核病的慢性特征表明，广泛耐药结核病可能是通过以前的治疗，包括二线药物获得。对这种传染病的积极管理是可行的，可以防止高死亡率和结核分枝杆菌耐药菌株的进一步传播。资助比尔和梅林达盖茨基金会、礼来基金会、开放社会研究所、布莱根妇女医院的弗兰克·哈奇全球卫生公平奖学金、美国传染病学会、海泽基金会、美国国立卫生研究院和约翰D和凯瑟琳T麦克阿瑟基金会。
Background Mycobacterium tuberculosis strains that cause untreatable drug-resistant disease are a threat worldwide. We describe the treatment, management, and outcomes of patients with extensively drug-resistant tuberculosis in Tomsk, Russia.Methods We undertook a retrospective cohort study of 608 patients with multidrug resistant tuberculosis who had treatment in civilian or prison services, between Sept 10, 2000, and Nov 1, 2004, according to the treatment strategy recommended by WHO. Clinical characteristics, management practices, and treatment outcomes of patients with extensively drug-resistant (XDR) tuberculosis and non-extensively drug-resistant (non-XDR) tuberculosis are described. The main outcome was the frequency of poor and favourable outcomes at the end of treatment.Findings Of 608 patients with multidrug resistant tuberculosis, 29 (4.8%) patients had baseline XDR tuberculosis. Treatment failure was more common in patients with XDR tuberculosis than in those with non-XDR tuberculosis (31% vs 8.5%, p=0.0008). 48.3% of patients with XDR tuberculosis and 66.7% of patients with non-XDR tuberculosis had treatment cure or completion (p=0.04). The frequency and management of adverse events did not differ between patients with XDR and non-XDR tuberculosis.Interpretation The chronic features of tuberculosis in these patients suggest that extensively drug-resistant tuberculosis may be acquired through previous treatments that include second-line drugs. Aggressive management of this infectious disease is feasible and can prevent high mortality rates and further transmission of drug-resistant strains of Mycobacterium tuberculosis.Funding Bill & Melinda Gates Foundation, Eli Lilly Foundation, The Open Society Institute, Frank Hatch Fellowships in Global Health Equity at the Brigham & Women's Hospital, Infectious Disease Society of America, the Heiser Foundation, the United States National Institutes of Health, and the John D and Catherine T MacArthur Foundation.