García Vázquez E, Esteban J, de Górgolas M, Fernández Guerrero M L
Departamento de Enfermedades Infecciosas, Fundación Jiménez Díaz, Universidad Autónoma de Madrid.
Rev Clin Esp. 1999 Sep;199(9):564-8.
Evaluation of epidemiologic, clinical and prognostic characteristics in cases of resistant tuberculosis (MRTB).
Retrospective longitudinal and observational study of resistant cases of tuberculosis at Fundación Jiménez Díaz (1991-1997). Statistical analysis of conventional tests and significance level at p < 0.05.
Twenty patients out of 558 with recovery of Mycobacterium tuberculosis showed resistance to some drugs (isoniazid, rifampicin, ethambutol, streptomycin or pyrazinamide). Information was gathered from 19 patients: eight (42%) HIV-positive patients; eight (42%) with the antecedent of tuberculosis (2 abandoned treatment). There were eleven cases (58%) of secondary resistance and eight of primary resistance but only five (25%) with multi-resistance criteria (1 primary and 4 secondary); five cases showed primary resistance to isoniazid. The number of resistances and HIV seropositivity or antecedent of prophylaxis was not statistically significant. In contrast, the higher number of resistances and tuberculosis antecedent were indeed statistically significant.
There was a low resistance rate at our institution. All multi-resistant cases had antecedents of therapy or prophylaxis abandon or previous tuberculosis. Only one case was MRTB. The relevance of complying with a proper therapy is emphasized (consider therapies directly monitored if there is risk of abandon). In patients with epidemiologic risk factors susceptibility studies should be performed and also start therapy with four drugs. The objective is to decrease the percentages of resistance and morbi-mortality.
评估耐多药结核病（MRTB）病例的流行病学、临床和预后特征。
对希门尼斯·迪亚斯基金会（1991 - 1997年）的结核病耐药病例进行回顾性纵向观察研究。采用常规检验进行统计分析，显著性水平为p < 0.05。
558例结核分枝杆菌康复患者中有20例对某些药物（异烟肼、利福平、乙胺丁醇、链霉素或吡嗪酰胺）耐药。收集了19例患者的信息：8例（42%）为HIV阳性患者；8例（42%）有结核病既往史（2例中断治疗）。有11例（58%）继发耐药，8例原发耐药，但只有5例（25%）符合多重耐药标准（1例原发和4例继发）；5例对异烟肼原发耐药。耐药数量与HIV血清学阳性或预防用药既往史无统计学意义。相比之下，耐药数量较多和有结核病既往史确实具有统计学意义。
我们机构的耐药率较低。所有多重耐药病例都有治疗或预防用药中断史或既往结核病病史。仅1例为耐多药结核病。强调了遵循适当治疗的重要性（如果有中断治疗风险，考虑直接督导治疗）。对于有流行病学危险因素的患者，应进行药敏研究，并开始四联药物治疗。目标是降低耐药率和疾病死亡率。
