Anti-Tuberculosis Drug Resistance among New and Previously Treated Sputum Smear-Positive Tuberculosis Patients in Uganda: Results of the First National Survey
Anti-Tuberculosis Drug Resistance among New and Previously Treated Sputum Smear-Positive Tuberculosis Patients in Uganda: Results of the First National Survey
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DOI：
10.1371/journal.pone.0070763
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发表时间：
2013-08-01
期刊：
影响因子：
3.7
通讯作者：
Joloba, Moses L.
中科院分区：
文献类型：
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作者：
Lukoye, Deus;Adatu, Francis;Joloba, Moses L.
背景：耐多药和广泛耐药结核病已成为全球结核病控制的主要威胁。乌干达的抗结核药物耐药率尚不清楚。我们开展了一项全国耐药调查，以调查新发和以前治疗过的痰涂阳结核病例对一线和二线抗结核药物的耐药水平和模式。方法：采用加权整群抽样方法，从2009年12月至2011年2月在结核病诊断中心登记的具有全国代表性的新发和以前治疗过的痰涂阳结核病患者中收集痰样本。在国家结核参考实验室进行培养和药敏试验。结果：共有来自44个卫生机构的1537名患者（1397名新患者和140名以前治疗过的患者）参加了调查。获得HIV检测结果1524例（96.8%），获得完整药敏试验结果1325例（85.9%）。在新发病例的1209株分离株中，对任一抗结核药物耐药的占10.3%，对异烟肼耐药的占5%，对利福平耐药的占1.9%，对多重耐药的占1.4%。从既往治疗病例分离的116株中，耐药率分别为25.9%、23.3%、12.1%和12.1%。在1524例接受HIV检测的患者中，469例（30.7%）呈阳性。抗结核药物耐药性（包括耐多药）与HIV感染之间没有关联。结论：与世卫组织的估计相比，乌干达新发患者中抗结核药物耐药性的流行率较低。在以前接受过治疗的患者中，耐多药结核病（12.1%）和任何药物耐药性（25.3%）的较高水平引起了对直接观察治疗（DOT）质量和治疗依从性的关注。这就要求加强现有的结核病控制措施，特别是dots、以前接受过治疗的结核病患者的常规DST或定期耐药性调查，以预防和监测耐药结核病的发展和传播。
Background: Multidrug resistant and extensively drug resistant tuberculosis (TB) have become major threats to control of tuberculosis globally. The rates of anti-TB drug resistance in Uganda are not known. We conducted a national drug resistance survey to investigate the levels and patterns of resistance to first and second line anti-TB drugs among new and previously treated sputum smear-positive TB cases.Methods: Sputum samples were collected from a nationally representative sample of new and previously treated sputum smear-positive TB patients registered at TB diagnostic centers during December 2009 to February 2011 using a weighted cluster sampling method. Culture and drug susceptibility testing was performed at the national TB reference laboratory.Results: A total of 1537 patients (1397 new and 140 previously treated) were enrolled in the survey from 44 health facilities. HIV test result and complete drug susceptibility testing (DST) results were available for 1524 (96.8%) and 1325 (85.9%) patients, respectively. Of the 1209 isolates from new cases, resistance to any anti-TB drug was 10.3%, 5% were resistant to isoniazid, 1.9% to rifampicin, and 1.4% were multi drug resistant. Among the 116 isolates from previously treated cases, the prevalence of resistance was 25.9%, 23.3%, 12.1% and 12.1% respectively. Of the 1524 patients who had HIV testing 469 (30.7%) tested positive. There was no association between anti-TB drug resistance (including MDR) and HIV infection.Conclusion: The prevalence of anti-TB drug resistance among new patients in Uganda is low relative to WHO estimates. The higher levels of MDR-TB (12.1%) and resistance to any drug (25.3%) among previously treated patients raises concerns about the quality of directly observed therapy (DOT) and adherence to treatment. This calls for strengthening existing TB control measures, especially DOT, routine DST among the previously treated TB patients or periodic drug resistance surveys, to prevent and monitor development and transmission of drug resistant TB.