Risk factors for rifampin-monoresistant tuberculosis - A case-control study
Risk factors for rifampin-monoresistant tuberculosis - A case-control study
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DOI：
10.1164/ajrccm.159.2.9805097
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发表时间：
1999-02-01
影响因子：
24.7
通讯作者：
Bonk, S
中科院分区：
文献类型：
--
作者：
Sandman, L;Schluger, NW;Bonk, S
利福平是治疗结核病 (TB) 的短程化疗的基石。利福平单药耐药性（RMR）比单独使用异烟肼或与其他抗结核药物联合使用的耐药性少见。我们进行了一项回顾性病例对照研究，以确定 RMR-TB 的危险因素。 1990 年至 1997 年间总共 26 名 RMR 患者中的 21 名患者的完整记录可供审查，并与 48 名药物敏感结核病患者的记录进行了比较，控制了诊断年份。病例比对照组更频繁地有结核病史（61% 对 22%，p < 0.01），并且更常见的是人类免疫缺陷病毒 (HIV) 阳性（81% 对 46%，p = 0.02）。在控制 HIV 状态的情况下，病例更有可能出现肺外受累（47.6% 对比 11.6%，p = 0.05）。 4 例病例 (19%) 和 1 例对照 (2.1%) 在住院期间死亡 (p = 0.02)。病例更常有监禁史（71.4% vs 37.5%，p = 0.09）。在 13 名有结核病史的病例中，有 5 名有吸收不良的证据（呕吐和/或腹泻），而 11 名对照者中没有人患有既往结核病。这些数据支持这样的假设：RMR 主要见于有结核病史且艾滋病毒呈阳性的个体。病例常常不依从先前的结核病治疗，有监禁史，并且结果不佳。
Rifampin is the cornerstone of short-course chemotherapy for the treatment of tuberculosis (TB). Rifampin monoresistance (RMR) is less common than resistance to isoniazid alone or in combination with other antituberculous medications. We conducted a retrospective case-control study to identify risk factors for RMR-TB. Complete records for 21 of a total of 26 RMR patients from 1990 to 1997 were available for review, and were compared with those of 48 patients with drug-susceptible TB, controlling for year of diagnosis. Cases more frequently had a history of TB than did controls (61% versus 22%, p < 0.01), and were more often human immunodeficiency virus (HIV) positive (81% versus 46%, p = 0.02). With control for HIV status, cases were more likely to have extrapulmonary involvement (47.6% versus 11.6%, p = 0.05). Four cases (19%) and one control (2.1%) died (p = 0.02) during hospitalization. Cases more often had a history of incarceration (71.4% versus 37.5%, p = 0.09). Among the 13 cases with a history of TB, five had evidence of malabsorption (vomiting and/or diarrhea), versus none of the 11 controls with prior TB. These data support the hypothesis that RMR is seen primarily in individuals with a history of TB and who are HIV positive. Cases were frequently noncompliant with previous treatment for TB, had a history of incarceration, and had poor outcomes.