Extensively Drug-Resistant Tuberculosis in the United States, 1993-2007
Extensively Drug-Resistant Tuberculosis in the United States, 1993-2007
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DOI：
10.1001/jama.300.18.2153
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发表时间：
2008-11-12
影响因子：
120.7
通讯作者：
Cegielski, J. Peter
中科院分区：
文献类型：
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作者：
Shah, N. Sarita;Pratt, Robert;Cegielski, J. Peter
背景广泛耐药结核病(XDR-TB)在全球范围内的出现引起了全球公共卫生的关注，因为治疗方案有限，死亡率很高。目的描述美国广泛耐药结核病的流行病学，并确定与多药耐药结核病(MDR-TB)和药物敏感结核病病例相比，XDR-TB病例的独特特征。根据初始和随访标本的药敏试验结果，广泛耐药结核病被定义为对异烟肼、利福霉素、氟喹诺酮以及至少1种阿米卡星、卡那霉素或卷曲霉素的耐药性。主要预后指标广泛耐药结核病病例计数和趋势、广泛耐药结核病的危险因素和总生存率。结果1993-2007年美国共报告83例广泛耐药结核病。迄今报告的广泛耐药结核病例数从1993年的18例(25107例中的0.07%)下降到2007年的2例(13293例中的0.02%)。在已知人类免疫缺陷病毒(HIV)检测结果的人中，31人(53%)艾滋病毒呈阳性。与耐多药结核病患者相比，广泛耐药结核病患者更有可能患有播散性结核病(患病率[PR]，2.06；95%可信区间[CI]，1.19-3.58)，不太可能转为痰培养阴性(PR，0.55；95%可信区间，0.33-0.94)，并有较长的感染期(培养转换的中位时间，MDR-TB为183天对93天；P
Context Worldwide emergence of extensively drug-resistant tuberculosis (XDR-TB) has raised global public health concern, given the limited therapy options and high mortality.Objectives To describe the epidemiology of XDR-TB in the United States and to identify unique characteristics of XDR- TB cases compared with multidrug- resistant TB (MDR-TB) and drug- susceptible TB cases.Design, Setting, and Patients Descriptive analysis of US TB cases reported from 1993 to 2007. Extensively drug- resistant TB was defined as resistance to isoniazid, a rifamycin, a fluoroquinolone, and at least 1 of amikacin, kanamycin, or capreomycin based on drug susceptibility test results from initial and follow- up specimens.Main Outcome Measures Extensively drug- resistant TB case counts and trends, risk factors for XDR- TB, and overall survival.Results A total of 83 cases of XDR- TB were reported in the United States from 1993 to 2007. The number of XDR- TB cases declined from 18 ( 0.07% of 25 107 TB cases) in 1993 to 2 ( 0.02% of 13 293 TB cases) in 2007, reported to date. Among those with known human immunodeficiency virus ( HIV) test results, 31 ( 53%) were HIV- positive. Compared with MDR- TB cases, XDR- TB cases were more likely to have disseminated TB disease ( prevalence ratio [ PR], 2.06; 95% confidence interval [ CI], 1.19- 3.58), less likely to convert to a negative sputum culture ( PR, 0.55; 95% CI, 0.33-0.94), and had a prolonged infectious period ( median time to culture conversion, 183 days vs 93 days for MDR- TB; P