THE EMERGENCE OF DRUG-RESISTANT TUBERCULOSIS IN NEW-YORK-CITY
THE EMERGENCE OF DRUG-RESISTANT TUBERCULOSIS IN NEW-YORK-CITY
复制标题
DOI：
10.1056/nejm199302253280801
复制
发表时间：
1993-02-25
影响因子：
158.5
通讯作者：
DOOLEY, SW
中科院分区：
文献类型：
--
作者：
FRIEDEN, TR;STERLING, T;DOOLEY, SW
背景资料。在过去的十年中，结核病的发病率在全国范围内有所增加，纽约市的发病率增加了一倍以上，那里最近发生了多药耐药结核病的医院暴发。1991年4月，我们收集了纽约市每一位结核分枝杆菌培养阳性患者的信息。药敏试验在疾病控制和预防中心进行。在518例培养阳性的患者中，466例(90%)有可供检测的分离株。总体而言，这些患者中有33%的菌株对一种或多种抗结核药物耐药，26%的菌株至少对异烟肼耐药，19%的菌株同时对异烟肼和利福平耐药。在接受抗结核治疗的239名患者中，44%的菌株对一种或多种药物耐药，30%的菌株同时对异烟肼和利福平耐药。在从未接受治疗的患者中，对一种或多种药物耐药的比例从1982年至1984年的10%上升到1991年的23%(P=0.003)。从未接受过治疗、感染了人类免疫缺陷病毒(HIV)或报告使用过注射毒品的患者更有可能感染耐药菌株。在患有获得性免疫缺陷综合症的患者中，那些携带耐药菌株的患者在截至1992年1月的随访中更有可能死亡(80%对47%，P=0.02)。抗结核治疗病史是耐药微生物存在的最强预测因子(优势比，2.7；P<；0.001)。纽约市的抗药性肺结核病例明显增加。以前接受治疗的患者、感染艾滋病毒的患者和注射吸毒者的抗药性风险增加。迫切需要采取措施控制和预防耐药结核病。
Background. in the past decade the incidence of tuberculosis has increased nationwide and more than doubled in New York City, where there have been recent nosocomial outbreaks of multidrug-resistant tuberculosis.Methods. We collected information on every patient in New York City with a positive culture for Mycobacterium tuberculosis during April 1991. Drug-susceptibility testing was performed at the Centers for Disease Control and Prevention.Results. Of the 518 patients with positive cultures, 466 (90 percent) had isolates available for testing. Overall, 33 percent of these patients had isolates resistant to one or more antituberculosis drugs, 26 percent had isolates resistant to at least isoniazid, and 19 percent had isolates resistant to both isoniazid and rifampin. Of the 239 patients who had received antituberculosis therapy, 44 percent had isolates resistant to one or more drugs and 30 percent had isolates resistant to both isoniazid and rifampin. Among the patients who had never been treated, the proportion with resistance to one or more drugs increased from 10 percent in 1982 through 1984 to 23 percent in 1991 (P = 0.003). Patients who had never been treated and who were infected with the human immunodeficiency virus (HIV) or reported injection-drug use were more likely to have resistant isolates. Among patients with the acquired immunodeficiency syndrome, those with resistant isolates were more likely to die during follow-up through January 1992 (80 percent vs. 47 percent, P = 0.02). A history of antituberculosis therapy was the strongest predictor of the presence of resistant organisms (odds ratio, 2.7; P < 0.001).Conclusions. There has been a marked increase in drug-resistant tuberculosis in New York City. Previously treated patients, those infected with HIV, and injection-drug users are at increased risk for drug resistance. Measures to control and prevent drug-resistant tuberculosis are urgently needed.