Treatment of multidrug-resistant tuberculosis in San Francisco: An outpatient-based approach
Treatment of multidrug-resistant tuberculosis in San Francisco: An outpatient-based approach
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DOI：
10.1086/428582
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发表时间：
2005-04-01
影响因子：
11.8
通讯作者：
Daley, CL
中科院分区：
文献类型：
--
作者：
Burgos, M;Gonzalez, LC;Daley, CL
背景资料。耐多药结核病患者的治疗需要长期治疗，通常需要长时间住院。尽管治疗强度大、费用高，但治愈率相对较低。我们回顾了1982-2000年在加利福尼亚州旧金山治疗的所有耐多药结核病患者的结果，并确定了1995-2000年期间治疗的患者的账单费用。以IS6110为基础的限制性片段长度多态性分析对结核分枝杆菌分离株进行基因分型。48例被鉴定为对3种药物(范围2-9种药物)的中位耐药。患者年龄中位数为49.5岁(22-78岁)，其中36例(75%)为外来出生，11例(23%)为人类免疫缺陷病毒(HIV)阳性，45例(94%)为肺结核。在33例HIV血清阴性患者中，32例(97%)治愈，仅1例在治疗5年后复发。11名HIV血清阳性患者在观察过程中全部死亡。21名患者(44%)需要住院治疗，住院时间中位数为14天(3-74天)。1994年后接受治疗的11名患者的住院和门诊总费用估计为519,928美元，每名患者的中位数费用为27,752美元。通过基于人群的基因分型，未发现继发性耐多药结核病病例。主要在门诊基础上治疗艾滋病毒血清阴性患者的耐多药结核病是可行的，而且与其他已发表的研究相比，与高治愈率和低成本有关。潜在的艾滋病毒感染患者的预后非常差。
Background. Treatment of patients with multidrug-resistant tuberculosis requires prolonged therapy, often involving long hospital stays. Despite intensive and costly therapy, cure rates are relatively low.Methods. We reviewed the outcomes for all patients with multidrug-resistant tuberculosis treated in San Francisco, California, during 1982-2000 and identified billing charges for patients treated during 1995-2000. Mycobacterium tuberculosis isolates were genotyped by IS6110-based restriction fragment-length polymorphism analysis.Results. Forty-eight cases were identified with resistance to a median of 3 drugs (range, 2-9 drugs). The median age of the patients was 49.5 years (range, 22-78 years); 36 (75%) of 48 patients were foreign born, 11 (23%) were human immunodeficiency virus (HIV) seropositive, and 45 (94%) had pulmonary tuberculosis. Thirty-two (97%) of the 33 HIV-seronegative patients were cured, with only 1 relapse occurring 5 years after treatment. All 11 HIV-seropositive patients died during observation. Twenty-one patients (44%) required hospitalization, with a median duration of stay of 14 days (range, 3-74 days). The estimated inpatient and outpatient aggregate cost for the 11 patients treated after 1994 was $519,928, with a median cost of $27,752 per patient. No secondary cases of multidrug-resistant tuberculosis were identified through population-based genotyping.Conclusions. Treatment of multidrug-resistant tuberculosis in HIV-seronegative patients largely on an outpatient basis was feasible and was associated with high cure rates and lower cost than in other published studies. Patients with underlying HIV infection had very poor outcomes.