Association between Mycobacterium tuberculosis lineage and time to sputum culture conversion
Association between Mycobacterium tuberculosis lineage and time to sputum culture conversion
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DOI：
10.5588/ijtld.12.0732
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发表时间：
2013-07-01
影响因子：
4
通讯作者：
Mac Kenzie, W. R.
中科院分区：
文献类型：
--
作者：
Click, E. S.;Winston, C. A.;Mac Kenzie, W. R.
背景：结核分枝杆菌包括四个主要的遗传谱系：一个进化上的祖先（印度洋）和三个现代。是否对结核病治疗的反应在不同的谱系中是未知的。设计：我们对2004年至2007年美国报告的肺结核（PTB）病例中痰培养转换的时间进行了一项探索性回顾性队列分析。结果：该分析包括13170例PTB病例，这些病例对接受标准四种药物治疗方案的一线药物无耐药性记录。在基线痰涂片结果阳性的病例中，相对于欧美血统的病例，印度洋血统的病例具有较高的痰培养转换校正风险（aHR 1.32，95% CI 1.20-1.45），而东非-印度或东亚血统的病例无差异（aHR 1.05，95% CI 0.88-1.25和aHR 0.99，95% CI 0.91-1.07）。在基线阴性痰涂片结果的情况下，痰培养转换的时间并没有不同的lineage.CONCLUSION：虽然这些结果是探索性的，他们认为，根除活菌可能会更快地发生在与印度洋血统的情况下，比那些与三个现代血统之一。需要按谱系对痰培养转化时间进行前瞻性研究。
SETTING: Mycobacterium tuberculosis comprises four principal genetic lineages: one evolutionarily ancestral (Indo-Oceanic) and three modern. Whether response to tuberculosis (TB) treatment differs among the lineages is unknown.OBJECTIVE: To examine the association between M. tuberculosis lineage and time to sputum culture conversion in response to standard first-line drug therapy.DESIGN: We conducted an exploratory retrospective cohort analysis of time to sputum culture conversion among pulmonary tuberculosis (PTB) cases reported in the United States from 2004 to 2007.RESULTS: The analysis included 13 170 PTB cases with no documented resistance to first-line drugs who received a standard four-drug treatment regimen. Among cases with baseline positive sputum smear results, relative to cases with Euro-American lineage, cases with Indo-Oceanic lineage had higher adjusted hazards of sputum culture conversion (aHR 1.32, 95% CI 1.20-1.45), whereas cases with East-African-Indian or East-Asian lineage did not differ (aHR 1.05, 95 % CI 0.88-1.25 and aHR 0.99, 95% CI 0.91-1.07, respectively). Among cases with baseline negative sputum smear results, time to sputum culture conversion did not differ by lineage.CONCLUSION: Although these results are exploratory, they suggest that the eradication of viable bacteria may occur sooner among cases with Indo-Oceanic lineage than among those with one of the three modern lineages. Prospective studies of time to sputum culture conversion by lineage are required.