Prolonged infectiousness of tuberculosis patients in a directly observed therapy short-course program with standardized therapy.
Prolonged infectiousness of tuberculosis patients in a directly observed therapy short-course program with standardized therapy.
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DOI：
10.1086/655127
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发表时间：
2010-08-15
期刊：
影响因子：
--
通讯作者：
Moore DA
中科院分区：
文献类型：
--
作者：
Fitzwater SP;Caviedes L;Gilman RH;Coronel J;LaChira D;Salazar C;Saravia JC;Reddy K;Friedland JS;Moore DA
有效的结核病控制受到缺乏明确的时间表可行的结核分枝杆菌脱落治疗开始后，在规划条件下。本研究量化了接受标准化短程直接观察治疗（DOTS）计划的肺结核患者从涂片和培养阳性转为阴性的时间。对秘鲁利马93例开始结核病治疗的成人进行纵向队列研究。采用MBBacT、比例法和显微镜观察药敏（MODS）法进行基线培养和药敏试验（DST）。在基线和每周一次共4周，然后每隔一周共26周进行一次涂片镜检和MODS液体培养。从培养阳性到培养阴性的中位转换时间为38.5天，不受基线涂片状态的影响。完全易感结核病患者的中位培养转换时间为37天; 10%的患者在第60天仍保持培养阳性。无论采用哪种DST方法，延迟的培养物转化与多药耐药相关;比例法和MODS（而不是MBBacT）定义的非多药耐药也与延迟相关。持续第60天涂片阳性检测多药耐药的阳性和阴性预测值分别为67%和92%。即使是完全易感的结核病患者，治疗后的结核病患者的痰菌和培养物转化所需的时间也比通常认为的要长，因此必须在结核病治疗和预防计划中加以考虑。持续60天涂片阳性是一个多药耐药的预测差。工业化国家的结核病患者普遍基线DST公约应成为受多药耐药性影响的资源有限环境中的护理标准。
Effective tuberculosis control is compromised by a lack of clarity about the timeframe of viable Mycobacterium tuberculosis shedding after treatment initiation under programmatic conditions. This study quantifies time to conversion from smear and culture positivity to negativity in unselected tuberculosis patients receiving standardized therapy in a directly observed therapy short-course (DOTS) program. Longitudinal cohort study following up 93 adults initiating tuberculosis therapy in Lima, Peru. Baseline culture and drug susceptibility tests (DSTs) were performed using the MBBacT, proportion, and microscopic observation drug susceptibility (MODS) methods. Smear microscopy and MODS liquid culture were performed at baseline and weekly for 4 weeks then every other week for 26 weeks. Median conversion time from culture positivity to culture negativity of 38.5 days was unaffected by baseline smear status. Patients with fully susceptible tuberculosis had a median time to culture conversion of 37 days; 10% remained culture positive at day 60. Delayed culture conversion was associated with multidrug resistance, regardless of DST method used; non–multidrug resistance as defined by the proportion method and MODS (but not MBBacT) was also associated with delay. Persistent day 60 smear positivity yielded positive and negative predictive values of 67% and 92%, respectively, for detecting multidrug resistance. Smear and culture conversion in treated tuberculosis patients takes longer than is conventionally believed, even with fully susceptible disease, and must be accounted for in tuberculosis treatment and prevention programs. Persistent day 60 smear positivity is a poor predictor of multidrug resistance. The industrialized-world convention of universal baseline DST for tuberculosis patients should become the standard of care in multidrug resistance–affected resource-limited settings.
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影响因子：
9.4
作者：
Moore, DAJ;Mendoza, D;Serpa, J
通讯作者：
Serpa, J
DOI：
10.1590/s0074-02762003000600020
发表时间：
2003-09-01
期刊：
Memórias do Instituto Oswaldo Cruz
影响因子：
--
作者：
Barreto, Angela Maria Werneck;Araújo, Joselba Borges Melo;Caldas, Paulo César de Souza
通讯作者：
Caldas, Paulo César de Souza
影响因子：
10
作者：
Hernández-Garduño, E;Cook, V;FitzGerald, JM
通讯作者：
FitzGerald, JM
影响因子：
168.9
作者：
Suárez, PG;Floyd, K;Espinal, MA
通讯作者：
Espinal, MA
影响因子：
168.9
作者：
Behr, MA;Warren, SA;Small, PM
通讯作者：
Small, PM