Outcome of culture-confirmed isoniazid-resistant rifampicin-susceptible tuberculosis in children.
Outcome of culture-confirmed isoniazid-resistant rifampicin-susceptible tuberculosis in children.
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DOI：
10.5588/ijtld.16.0293
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发表时间：
2016-11
期刊：
影响因子：
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通讯作者：
A. Garcia-Prats;L. D. Plessis;H. Draper;A.E.C. Burger;J. Seddon;K. Zimri;A. Hesseling;H. S. Schaaf
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文献类型：
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作者：
A. Garcia-Prats;L. D. Plessis;H. Draper;A.E.C. Burger;J. Seddon;K. Zimri;A. Hesseling;H. S. Schaaf
异烟肼耐药利福平敏感（HRRS）结核病（TB）是全球最常见的耐药结核病，可能是不良结局的危险因素，但在儿童中的描述很少。目的明确培养证实的HRRS结核病儿童的临床表现、治疗、临床和微生物学结局。设计回顾性医院队列研究。结果在纳入研究的72名儿童中，中位年龄为50.1个月（IQR 21.5-102.5）; 42%为男性。44例（51%）有潜在的源病例;只有13例被确认为HRRS TB。在66例受检者中，12例（17%）为人类免疫缺陷病毒（HIV）感染者，60例肺结核（PTB）患者中有36例（60%）病情严重。70名儿童有治疗数据;中位总治疗持续时间为11.3个月（IQR 9-12.3）; 25名（36%）开始了三种药物强化阶段的治疗; 52名（74%）接受了氟喹诺酮类药物。在63例已知结局的儿童中，55例（88%）结局良好，1例死亡，3例治疗失败。10例患者在开始治疗后12个月随访培养阳性。年龄较大（P = 0.008）、既往抗结核治疗（P = 0.023）和重度PTB（P = 0.018）与12个月时培养物转化失败相关。结论：虽然总体结果良好，但长期培养阳性和治疗失败的病例强调需要额外关注HRRS TB儿童的管理。
SETTING Isoniazid-resistant rifampicin-susceptible (HRRS) tuberculosis (TB) is the most prevalent form of drug-resistant TB globally, and may be a risk factor for poor outcomes, but has been poorly described in children. OBJECTIVE To characterise the clinical presentation, treatment, and clinical and microbiological outcomes among children with culture-confirmed HRRS TB. DESIGN Retrospective hospital-based cohort study. RESULTS Of the 72 children included in the study, the median age was 50.1 months (IQR 21.5-102.5); 42% were male. Forty-four (51%) had a potential source case; only 13 were confirmed HRRS TB. Of 66 tested, 12 (17%) were human immunodeficiency virus (HIV) infected, and 36 (60%) of the 60 with pulmonary TB (PTB) had severe disease. Seventy children had treatment data; the median total duration of treatment was 11.3 months (IQR 9-12.3); 25 (36%) initiated treatment with a three-drug intensive phase; 52 (74%) received a fluoroquinolone. Of 63 children with known outcomes, 55 (88%) had a favourable outcome, 1 died and 3 had treatment failure. Ten had positive follow-up cultures at ⩾2 months after starting treatment. Older age (P = 0.008), previous anti-tuberculosis treatment (P = 0.023) and severe PTB (P = 0.018) were associated with failure to culture-convert at ⩾2 months. CONCLUSIONS Although overall outcomes were good, prolonged culture positivity and cases of treatment failure emphasise the need for additional attention to the management of children with HRRS TB.