Al-Marri M R
Qatar Armed Forces Medical Services, Pulmonary, Sleep and Critical Care Medicine, Hamad General Hospital, Doha, Arabian Gulf.
Int J Tuberc Lung Dis. 2001 Dec;5(12):1116-21.
To determine the resistance pattern of Mycobacterium tuberculosis to four anti-tuberculosis drugs in pulmonary tuberculosis patients in the State of Qatar after the implementation of DOTS and an expatriate screening programme on arrival.
A state-wide, population-based, retrospective analysis of all cases of pulmonary tuberculosis with positive M. tuberculosis culture reported to the Division of Public Health TB Unit from January 1996 to December 1998. M. tuberculosis sensitivity testing was done by the Bactec method for isoniazid (INH), rifampicin (RMP), streptomycin (SM) and ethambutol (EMB). The results were interpreted as a daily change of the growth index of test vials (with drug) compared with controls.
There were 406 isolates with positive M. tuberculosis culture. Sixty-one (15%) were resistant to one or more of the four anti-tuberculosis drugs, of which 58 (95%) were from newly diagnosed cases (primary) and three (5%) were from previously treated cases (acquired). Primary resistance was as follows: any resistance 15%, INH 12.4%, RMP 2%, SM 5.2%, EMB 0.8% and multidrug resistance (MDR, resistance to INH and RMP at least) was found in 0.8%. Acquired resistance was as follows: any resistance 15%, INH 15%, RMP 5%, SM 5% and MDR 5%.
The prevalence of resistance to four anti-tuberculosis drugs is strikingly low due to the limited expatriate screening programme (chest radiography) and implementation of DOTS. The four-drug regimen is recommended for the initial phase of therapy until the results of sensitivity testing are known.
在实施直接观察下的短程化疗（DOTS）及对入境外籍人员的筛查计划后，确定卡塔尔国肺结核患者中结核分枝杆菌对四种抗结核药物的耐药模式。
对1996年1月至1998年12月向公共卫生部门结核病科报告的所有结核分枝杆菌培养阳性的肺结核病例进行全州范围、基于人群的回顾性分析。采用Bactec法对结核分枝杆菌进行异烟肼（INH）、利福平（RMP）、链霉素（SM）和乙胺丁醇（EMB）敏感性检测。结果通过比较含药测试瓶与对照瓶生长指数的每日变化来解读。
有406株结核分枝杆菌培养阳性菌株。61株（15%）对四种抗结核药物中的一种或多种耐药，其中58株（95%）来自新诊断病例（初治），3株（5%）来自既往治疗病例（获得性）。初治耐药情况如下：任何耐药15%，INH耐药12.4%，RMP耐药2%，SM耐药5.2%，EMB耐药0.8%，多重耐药（MDR，至少对INH和RMP耐药）为0.8%。获得性耐药情况如下：任何耐药15%，INH耐药15%，RMP耐药5%，SM耐药5%，MDR耐药5%。
由于外籍人员筛查计划（胸部X光检查）有限及DOTS的实施，对四种抗结核药物的耐药率极低。在药敏试验结果出来之前，推荐在治疗初期采用四联疗法。
