Burden of transmitted multidrug resistance in epidemics of tuberculosis: a transmission modelling analysis.
Burden of transmitted multidrug resistance in epidemics of tuberculosis: a transmission modelling analysis.
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DOI：
10.1016/s2213-2600(15)00458-0
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发表时间：
2015-12
期刊：
影响因子：
--
通讯作者：
Dowdy DW
中科院分区：
文献类型：
--
作者：
Kendall EA;Fofana MO;Dowdy DW
耐多药结核病（MDR-TB）可以通过结核病治疗期间的新生突变或通过其他活动性MDR-TB患者的传播获得。在为耐多药结核病分配资源时，了解这两种机制之间的平衡至关重要。我们构建了一个耐多药结核病流行的动态传播模型，考虑到与治疗相关的获得和人与人之间的耐药性传播。我们使用国家结核病通报数据，为贝叶斯估计每个国家2013年MDR结核病发病率中由MDR传播而非治疗相关MDR获得导致的比例提供信息。全球估计新报告的耐多药结核病患病率为3.5%，复治报告的耐多药结核病患病率为20.5%，这意味着耐药传播而非获得占所有耐多药结核病发病率的中位数为96%（95% UR：68-100%），占既往接受过治疗的个体耐多药结核病发病率的61%（16-95%）。不同国家的通报数据显示，由传播导致的耐多药结核病的估计百分比差异很大;例如，我们估计孟加拉国的这一百分比为48%（30-75%），而乌兹别克斯坦为99%（91-100%）。估计是最敏感的估计多药耐药菌株的传播性，获得耐药结核病治疗过程中的概率，耐药结核病的一线治疗的反应。大多数高负担环境中的MDR患病率与绝大多数由传播而非新的治疗相关耐药获得引起的MDR-TB事件最为一致。仅仅改善对药物敏感的结核病的治疗不太可能大大降低未来耐多药结核病的发病率。改进耐多药结核病的诊断和治疗--包括新的检测方法和药物治疗方案--应列为高度优先事项。
Multidrug-resistant tuberculosis (MDR-TB) can be acquired through de novo mutation during TB treatment or through transmission from other individuals with active MDR-TB. Understanding the balance between these two mechanisms is essential when allocating resources for MDR-TB. We constructed a dynamic transmission model of an MDR-TB epidemic, allowing for both treatment-related acquisition and person-to-person transmission of resistance. We used national TB notification data to inform Bayesian estimates of the fraction of each country’s 2013 MDR-TB incidence that resulted from MDR transmission rather than treatment-related MDR acquisition. Global estimates of 3·5% MDR-TB prevalence among new TB notifications and 20·5% among retreatment notifications translate into an estimate that resistance transmission rather than acquisition accounts for a median 96% (95% UR: 68–100%) of all incident MDR-TB, and 61% (16–95%) of incident MDR-TB in previously-treated individuals. The estimated percentage of MDR-TB resulting from transmission varied substantially with different countries’ notification data; for example, we estimated this percentage at 48% (30–75%) of MDR-TB in Bangladesh, versus 99% (91–100%) in Uzbekistan. Estimates were most sensitive to estimates of the transmissibility of MDR strains, the probability of acquiring MDR during tuberculosis treatment, and the responsiveness of MDR TB to first-line treatment. Notifications of MDR prevalence from most high-burden settings are most consistent with the vast majority of incident MDR-TB resulting from transmission rather than new treatment-related acquisition of resistance. Merely improving the treatment of drug-susceptible TB is unlikely to greatly reduce future MDR-TB incidence. Improved diagnosis and treatment of MDR-TB – including new tests and drug regimens – should be highly prioritized.