Multidrug-resistant tuberculosis drug susceptibility and molecular diagnostic testing.
Multidrug-resistant tuberculosis drug susceptibility and molecular diagnostic testing.
复制标题
多药的结核病药物易感性和分子诊断测试。
DOI：
10.1097/maj.0b013e31825d32c6
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发表时间：
2013-02
期刊：
影响因子：
--
通讯作者：
Nguyen ML
中科院分区：
文献类型：
--
作者：
Kalokhe AS;Shafiq M;Lee JC;Ray SM;Wang YF;Metchock B;Anderson AM;Nguyen ML
耐多药结核病(MDR TB)的定义是对两种最有效的一线药物异烟肼和利福平的耐药性，在全球范围内呈上升趋势，并与显著的发病率和死亡率有关。尽管结核分枝杆菌(Mtb)药敏试验(DST)的新型快速诊断工具越来越多，但这些方法的临床适用性尚不确定。在这里，我们回顾了结核分枝杆菌对异烟肼和利福平的作用机制和耐药性，以及现有的结核分枝杆菌DST工具的实用性、优势和局限性。我们特别强调快速转向的分子方法，包括线探针分析、基于分子信标的实时聚合酶链式反应和焦磷酸测序。我们的结论是，无论是快速分子药物检测还是表型方法都不能完美地预测结核分枝杆菌的药物敏感性，因此必须在每个患者的临床背景下进行解释。
Multidrug resistant tuberculosis (MDR TB), defined by resistance to the two most effective first-line drugs, isoniazid and rifampin, is on the rise globally and is associated with significant morbidity and mortality. Despite the increasing availability of novel, rapid diagnostic tools for Mycobacterium tuberculosis (Mtb) drug susceptibility testing (DST), the clinical applicability of these methods is unsettled. Here, we review the mechanisms of action and resistance of Mtb to isoniazid and rifampin as well as the utility, advantages, and limitations of the available Mtb DST tools. We place particular emphasis on molecular methods with rapid turn-around including line probe assays, molecular beacon-based real time-polymerase chain reaction, and pyrosequencing. We conclude that neither rapid molecular drug testing nor phenotypic methods are perfect in predicting MTB drug susceptibility, and therefore must be interpreted within the clinical context of each patient.