Extensively drug-resistant tuberculosis in the UK: 1995 to 2007
Extensively drug-resistant tuberculosis in the UK: 1995 to 2007
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DOI：
10.1136/thx.2008.108712
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发表时间：
2009-06-01
期刊：
影响因子：
10
通讯作者：
Watson, J. M.
中科院分区：
文献类型：
--
作者：
Abubakar, I.;Moore, J.;Watson, J. M.
背景：耐多药结核病(MDRTB)和广泛耐药结核病(XDRTB)的出现对全球结核病控制构成威胁。然而，关于XDRTB病例结果的信息有限。本研究描述了MDRTB病例对二线和三线抗结核药物的敏感性以及确诊的XDRTB病例的治疗结果。方法：回顾1995年1月至2007年12月英国二线抗结核药物敏感性试验的结果，并联系临床医生了解XDRTB病例的治疗结果。参与者包括英国所有678名经培养确认的MDRTB患者。结果：MDRTB分离株对阿米卡星、卷曲霉素、环丙沙星、环丝氨酸、乙硫酰胺和对氨基水杨酸的耐药率分别为5.5%、3.4%、5.6%、5.1%、14.0%和16.7%。在此期间发现了6例XDRTB病例(占耐多药病例的0.9%)。2008年又报告了两例XDRTB病例。5例XDRTB患者在确诊后3年内死于结核病，3例仍在接受治疗。结论：在这个高收入国家，MDRTB水平仍然很低，XDRTB水平非常低。尽管艾滋病毒合并感染水平较低，但XDRTB病例的病死率很高。
Background: The emergence of multidrug-resistant tuberculosis (MDRTB) and extensively drug-resistant tuberculosis (XDRTB) is a threat to global tuberculosis control. Limited information is, however, available on the outcome of XDRTB cases. This study describes the susceptibility to second-and third-line antituberculosis drugs among MDRTB cases and treatment outcome of identified XDRTB cases.Method: The results of second-line antituberculosis drug susceptibility tests in the UK between January 1995 and December 2007 were retrospectively reviewed and clinicians contacted for treatment outcome of XDRTB cases. Participants included all 678 patients with culture-confirmed MDRTB in the UK. The main outcome measures were the proportion of isolates resistant to second-line antituberculosis drugs and treatment outcome for XDRTB cases.Results: Among MDRTB isolates, levels of resistance to amikacin, capreomycin, ciprofloxacin, cycloserine, ethionamide and p-aminosalicylic acid (PAS) were 5.5, 3.4, 5.6, 5.1, 14.0 and 16.7%, respectively. Six XDRTB cases (0.9% of MDR cases) were identified during this period. Two further cases of XDRTB were reported in 2008. Five individuals with XDRTB died of tuberculosis within 3 years of diagnosis and three are still on treatment.Conclusion: Levels of MDRTB remain low, and those of XDRTB very low, in this high income country. The case fatality ratio among XDRTB cases was high despite low levels of HIV co-infection.