墨西哥南部一个郊区社区的结核分枝杆菌耐药性

Mycobacterium tuberculosis drug resistance in a suburban community in southern Mexico.

作者信息

García-García M L, Jiménez-Corona M E, Ponce-de-León A, Jiménez-Corona A, Palacios-Martínez M, Balandrano-Campos S, Ferreyra-Reyes L, Juárez-Sandino L, Sifuentes-Osornio J, Olivera-Díaz H, Valdespino-Gómez J L, Small P M

机构信息

Instituto Nacional de Salud Pública, Cuernavaca, Mexicó.

出版信息

Int J Tuberc Lung Dis. 2000 Dec;4(12 Suppl 2):S168-70.

PMID:11144548

Abstract

OBJECTIVE

To determine the impact of drug resistance (DR) on the clinical outcome and transmission of tuberculosis under programmatic conditions.

METHODS

Prospective cohort and molecular epidemiologic study in the Orizaba Health Jurisdiction of Mexico. Between March 1995 and July 1999, chronic coughers with positive acid-fast bacilli (AFB) detected in sputum smear underwent clinical and mycobacteriologic evaluation (species identification, drug susceptibility testing and IS6110-based genotyping). Treatment was provided in accordance with official norms.

RESULTS

Mycobacterium tuberculosis was isolated from 326/387 AFB-positive cases. The rate of DR was 24.2% and that of multidrug resistance (MDR, defined as resistance to both isoniazid and rifampin at least) was 7.7%; 78% were cured, 8% abandoned treatment, 6% failed treatment, and 5% died. An additional 13.5% received retreatment and 8.9% died during a median 28.6 months of follow up. Factors associated with DR by multivariate analysis were chronicity of tuberculosis (OR 4.8, 95%CI 2.7-8.4, P < 0.001), age >40 years (OR 1.9, 95%CI 1.1-3.2, P = 0.02) and indigenous origin (OR 0.3, 95%CI 0.13-0.75, P = 0.01). Cox-adjusted relative risks showed that MDR (RR 2.5, 95%CI 1.02-6.16, P = 0.04), HIV infection (RR 31.3, 95%CI 11.6-84.8, P < 0.001), and chronicity of tuberculosis (RR 2.1, 95%CI 1.0-4.4, P = 0.06) were associated with mortality, controlling for age. Predictors of retreatment were DR (not including MDR) (RR 2.2 95%CI 0.89-5.31, P < 0.087), MDR (RR 12.6, 95%CI 5.46-28.88, P < 0.001), and living in a household with an earthen floor (RR 2.8, 95%CI 1.27-6.13, P = 0.011). Being infected with MDR-TB was the only factor associated with a decreased likelihood of being in an RFLP cluster (OR 0.31, 95%CI 0.12-0.81, P = 0.02).

CONCLUSIONS

Although MDR-TB may have a decreased propensity to spread and cause disease, it has a profoundly negative impact on tuberculosis control.

摘要

目的

确定在规划条件下耐药性（DR）对结核病临床结局及传播的影响。

方法

在墨西哥奥里萨巴卫生辖区进行前瞻性队列和分子流行病学研究。1995年3月至1999年7月，对痰涂片抗酸杆菌（AFB）检测呈阳性的慢性咳嗽患者进行临床和分枝杆菌学评估（菌种鉴定、药敏试验及基于IS6110的基因分型）。治疗按照官方规范进行。

结果

从387例AFB阳性病例中分离出结核分枝杆菌326例。耐药率为24.2%，多重耐药率（MDR，定义为至少对异烟肼和利福平耐药）为7.7%；78%治愈，8%放弃治疗，6%治疗失败，5%死亡。在中位随访28.6个月期间，另有13.5%接受再次治疗，8.9%死亡。多变量分析显示与耐药相关的因素有结核病的慢性病程（比值比[OR]4.8，95%置信区间[CI]2.7 - 8.4，P < 0.001）、年龄>40岁（OR 1.9，95%CI 1.1 - 3.2，P = 0.02）及原住民身份（OR 0.3，95%CI 0.13 - 0.75，P = 0.01）。Cox调整相对风险显示，控制年龄后，MDR（相对风险[RR]2.5，95%CI 1.02 - 6.16，P = 0.04）、HIV感染（RR 31.3，95%CI 11.6 - 84.8，P < 0.001）及结核病的慢性病程（RR 2.1，95%CI 1.0 - 4.4，P = 0.06）与死亡率相关。再次治疗的预测因素为耐药（不包括MDR）（RR 2.2，95%CI 0.89 - 5.31，P < 0.087）、MDR（RR 12.6，95%CI 5.46 - 28.88，P < 0.001）及居住在泥土地面房屋（RR 2.8，95%CI 1.27 - 6.13，P = 0.011）。感染耐多药结核病是与限制性片段长度多态性（RFLP）聚类可能性降低相关的唯一因素（OR 0.31，95%CI 0.12 - 0.81，P = 0.02）。