Global trends in resistance to antituberculosis drugs
Global trends in resistance to antituberculosis drugs
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DOI：
10.1056/nejm200104263441706
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发表时间：
2001-04-26
影响因子：
158.5
通讯作者：
Raviglione, MC
中科院分区：
文献类型：
--
作者：
Espinal, MA;Laszlo, A;Raviglione, MC
背景资料：抗结核药物耐药性的全球趋势缺乏数据。方法：我们扩大了世界卫生组织和国际防治结核病和肺病联盟进行的调查，以评估六大洲国家抗结核药物耐药性的趋势。我们使用标准方案从正在进行的监测或所有结核病患者的代表性样本调查中获得数据。标准的抽样技术区分新的和以前治疗的患者，和实验室性能进行了检查，通过一个国际程序的质量assurance.Results：在1996年和1999年之间，在58个地理位置的患者进行了调查，28个网站提供的数据至少两年。对于新诊断的结核病患者，对至少一种抗结核药物耐药的频率从乌拉圭的1.7%到爱沙尼亚的36.9%不等（中位数为10.7%）。爱沙尼亚的流行率从1994年的28.2%上升到1998年的36.9%（P=0.01），丹麦从1995年的9.9%上升到1998年的13.1%（P=0.04）。结核病新发病例中多药耐药流行率中位数仅为1.0%，但爱沙尼亚的流行率要高得多（14.1%），中国河南省（10.8%），拉脱维亚俄罗斯的伊万诺沃州（9.0%）和托木斯克州（6.5%）、伊朗（5.0%）和中国的浙江省（4.5%）。法国和美国的多药耐药性显著下降。在爱沙尼亚，所有病例的流行率从1994年的11.7%上升到1998年的18.1%（P
Background: Data on global trends in resistance to antituberculosis drugs are lacking.Methods: We expanded the survey conducted by the World Health Organization and the International Union against Tuberculosis and Lung Disease to assess trends in resistance to antituberculosis drugs in countries on six continents. We obtained data using standard protocols from ongoing surveillance or from surveys of representative samples of all patients with tuberculosis. The standard sampling techniques distinguished between new and previously treated patients, and laboratory performance was checked by means of an international program of quality assurance.Results: Between 1996 and 1999, patients in 58 geographic sites were surveyed; 28 sites provided data for at least two years. For patients with newly diagnosed tuberculosis, the frequency of resistance to at least one antituberculosis drug ranged from 1.7 percent in Uruguay to 36.9 percent in Estonia (median, 10.7 percent). The prevalence increased in Estonia, from 28.2 percent in 1994 to 36.9 percent in 1998 (P=0.01), and in Denmark, from 9.9 percent in 1995 to 13.1 percent in 1998 (P=0.04). The median prevalence of multidrug resistance among new cases of tuberculosis was only 1.0 percent, but the prevalence was much higher in Estonia (14.1 percent), Henan Province in China (10.8 percent), Latvia (9.0 percent), the Russian oblasts of Ivanovo (9.0 percent) and Tomsk (6.5 percent), Iran (5.0 percent), and Zhejiang Province in China (4.5 percent). There were significant decreases in multidrug resistance in France and the United States. In Estonia, the prevalence in all cases increased from 11.7 percent in 1994 to 18.1 percent in 1998 (P