Hannan M M, Peres H, Maltez F, Hayward A C, Machado J, Morgado A, Proenca R, Nelson M R, Bico J, Young D B, Gazzard B S
Department of Medical Microbiology and HIV/Genito-Urinary Medicine Unit, Chelsea and Westminster Hospital, 369 Fulham Rd, London, UK.
J Hosp Infect. 2001 Feb;47(2):91-7. doi: 10.1053/jhin.2000.0884.
An increase in the number of new cases of tuberculosis (TB) combined with poor clinical outcome was identified among HIV-infected injecting drug users attending a large HIV unit in central Lisbon. A retrospective epidemiological and laboratory study was conducted to review all newly diagnosed cases of TB from 1995 to 1996 in the HIV unit. Results showed that from 1995 to 1996, 63% (109/173) of the Mycobacterium tuberculosis isolates from HIV-infected patients were resistant to one or more anti-tuberculosis drugs; 89% (95) of these were multidrug-resistant, i.e., resistant to at least isoniazid and rifampicin. Eighty percent of the multidrug-resistant strains (MDR) available for restriction fragment length polymorphism (RFLP) DNA fingerprinting clustered into one of two large clusters. Epidemiological data support the conclusion that the transmission of MDR-TB occurred among HIV-infected injecting drug users exposed to infectious TB cases on open wards in the HIV unit. Improved infection control measures on the HIV unit and the use of empirical therapy with six drugs once patients were suspected to have TB, reduced the incidence of MDR-TB from 42% of TB cases in 1996 to 11% in 1999.
在里斯本中部一家大型艾滋病治疗中心就诊的感染艾滋病毒的注射吸毒者中，发现结核病（TB）新病例数量增加且临床预后不佳。开展了一项回顾性流行病学和实验室研究，以审查该艾滋病治疗中心1995年至1996年所有新诊断的结核病病例。结果显示，1995年至1996年，来自感染艾滋病毒患者的结核分枝杆菌分离株中有63%（109/173）对一种或多种抗结核药物耐药；其中89%（95株）为耐多药，即至少对异烟肼和利福平耐药。可用于限制性片段长度多态性（RFLP）DNA指纹分析的耐多药菌株（MDR）中，80%聚集在两个大簇中的一个。流行病学数据支持以下结论：耐多药结核病在感染艾滋病毒的注射吸毒者中传播，这些吸毒者在艾滋病治疗中心的开放式病房接触到传染性结核病病例。艾滋病治疗中心加强了感染控制措施，并在患者疑似感染结核病时使用六种药物进行经验性治疗，使耐多药结核病的发病率从1996年占结核病病例的42%降至1999年的11%。
