Extensively drug-resistant tuberculosis as a cause of death in patients co-infected with tuberculosis and HIV in a rural area of South Africa
Extensively drug-resistant tuberculosis as a cause of death in patients co-infected with tuberculosis and HIV in a rural area of South Africa
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DOI：
10.1016/s0140-6736(06)69573-1
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发表时间：
2006-11-04
期刊：
影响因子：
168.9
通讯作者：
Friedland, Gerald
中科院分区：
文献类型：
--
作者：
Gandhi, Neel R.;Moll, Anthony;Friedland, Gerald
背景南非的HIV-1和结核病的流行密切相关。抗逆转录病毒治疗改善了合并感染患者的高死亡率。虽然结核病的治疗已取得了进展，但耐药结核病已成为死亡的主要原因。我们评估了在夸祖鲁纳塔尔，南非的农村地区的耐多药（MDR）和广泛耐药（XDR）结核病的患病率和后果。方法我们进行了加强监测耐药结核病与痰培养和药物敏感性试验的患者与已知或疑似结核病。结果从2005年1月至2006年3月，共采集痰标本1539例，其中1539例对一线和二线药物耐药。我们在221例患者中检测到MDR结核，其中53例为XDR结核。在475例经培养证实的结核病患者中，MDR的患病率为39%（185例患者），XDR结核的患病率为6%（30例患者）。只有55%（26/47）的XDR结核病患者以前从未接受过结核病治疗; 67%（28/42）的患者最近住院。所有44名接受艾滋病毒检测的XDR结核病患者都是合并感染。53例XDR结核患者中有52例死亡，在42例确认死亡日期的患者中，自诊断（IQR 6-37）起的中位生存期为16天。分离株的基因分型结果显示，46例（85%，95%CI 74-95）XDR结核病患者中有39例具有相似的strain.Conclusions耐多药结核病比以前实现在这种情况下更普遍。XDR结核病已传播给艾滋病毒合并感染的患者，并与高死亡率有关。这些情况需要紧急干预，并威胁到结核病和艾滋病毒治疗方案的成功。
Background The epidemics of HIV-1 and tuberculosis in South Africa are closely related. High mortality rates in co-infected patients have improved with antiretroviral. therapy, but drug-resistant tuberculosis has emerged as a major cause of death. We assessed the prevalence and consequences of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis in a rural area in KwaZulu Natal, South Africa.Methods We undertook enhanced surveillance for drug-resistant tuberculosis with sputum culture and drug susceptibility testing in patients with known or suspected tuberculosis. Genotyping was done for isolates resistant to first-line and second-line drugs.Results From January, 2005, to March, 2006, sputum was obtained from 1539 patients. We detected MDR tuberculosis in 221 patients, of whom 53 had XDR tuberculosis. Prevalence among 475 patients with culture-confirmed tuberculosis was 39% (185 patients) for MDR and 6% (30) for XDR tuberculosis. Only 55% (26 of 47) of patients with XDR tuberculosis had never been previously treated for tuberculosis; 67% (28 of 42) had a recent hospital admission. All 44 patients with XDR tuberculosis who were tested for HIV were co-infected. 52 of 53 patients with XDR tuberculosis died, with median survival of 16 days from time of diagnosis (IQR 6-37) among the 42 patients with confirmed dates of death. Genotyping of isolates showed that 39 of 46 (85%, 95% Cl 74-95) patients with XDR tuberculosis had similar strains.Conclusions MDR tuberculosis is more prevalent than previously realised in this setting. XDR tuberculosis has been transmitted to HIV co-infected patients and is associated with high mortality. These observations warrant urgent intervention and threaten the success of treatment programmes for tuberculosis and HIV.