Rate and amplification of drug resistance among previously-treated patients with tuberculosis in Kampala, Uganda.
Rate and amplification of drug resistance among previously-treated patients with tuberculosis in Kampala, Uganda.
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DOI：
10.1086/592252
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发表时间：
2008-11-01
期刊：
影响因子：
--
通讯作者：
Jones-López EC
中科院分区：
文献类型：
--
作者：
Temple B;Ayakaka I;Ogwang S;Nabanjja H;Kayes S;Nakubulwa S;Worodria W;Levin J;Joloba M;Okwera A;Eisenach KD;McNerney R;Elliott AM;Smith PG;Mugerwa RD;Ellner JJ;Jones-López EC
耐药结核分枝杆菌已成为全球性威胁。在资源有限的情况下，有结核病治疗史的患者可能患有耐药性疾病，可能会出现不良结局。有必要衡量这些患者的耐药性程度和风险因素。从2003年7月到2006年11月，我们在乌干达的坎帕拉招募了410名既往接受过治疗的结核病患者。我们测量了一线和二线药物耐药的患病率，并分析了与基线和获得性耐药相关的风险因素。耐多药结核病的患病率为12.7%（95%置信区间[95%CI]，9.6%-16.3%）。二线药物耐药率低。入组时与耐多药结核病相关的因素包括治疗失败史（比值比，23.6; 95%CI，7.7-72.4）、既往多次结核病发作（比值比，15.6; 95%CI，5.0-49.1）和胸片上存在空洞（比值比，5.9; 95%CI，1.2-29.5）。在250例患者的队列中，5.2%（95%CI，2.8%-8.7%）感染了M。结核病产生了额外的耐药性。耐药性的增强与基线时已有的耐药性（P<0.01）和延迟的痰培养转换（P<0.01）有关。在乌干达，以前接受过治疗的结核病患者的耐药性负担相当大，产生额外耐药性的风险很大。迫切需要改善低收入国家此类患者的治疗。
Drug-resistant Mycobacterium tuberculosis has emerged as a global threat. In resource-constrained settings, patients with a history of tuberculosis (TB) treatment may have drug-resistant disease and may experience poor outcomes. There is a need to measure the extent of and risk factors for drug resistance in such patients. From July 2003 through November 2006, we enrolled 410 previously treated patients with TB in Kampala, Uganda. We measured the prevalence of resistance to first- and second-line drugs and analyzed risk factors associated with baseline and acquired drug resistance. The prevalence of multidrug-resistant TB was 12.7% (95% confidence interval [95% CI], 9.6%–16.3%). Resistance to second-line drugs was low. Factors associated with multidrug-resistant TB at enrollment included a history of treatment failure (odds ratio, 23.6; 95% CI, 7.7–72.4), multiple previous TB episodes (odds ratio, 15.6; 95% CI, 5.0–49.1), and cavities present on chest radiograph (odds ratio, 5.9; 95% CI, 1.2–29.5). Among a cohort of 250 patients, 5.2% (95% CI, 2.8%–8.7%) were infected with M. tuberculosis that developed additional drug resistance. Amplification of drug resistance was associated with existing drug resistance at baseline (P<.01) and delayed sputum culture conversion (P<.01). The burden of drug resistance in previously treated patients with TB in Uganda is sizeable, and the risk of generating additional drug resistance is significant. There is an urgent need to improve the treatment for such patients in low-income countries.
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