Kartaloglu Zafer, Bozkanat Erkan, Ozturkeri Hakan, Okutan Oguzhan, Ilvan Ahmet
Gata Camlica Chest Diseases Hospital, Istanbul, Turkey.
Med Princ Pract. 2002 Oct-Dec;11(4):202-5. doi: 10.1159/000065815.
The aim of this study was to investigate the prevalence of primary drug resistance to tuberculosis.
We evaluated the clinical data, radiological features and sputum samples from 365 newly diagnosed patients with a positive culture of pulmonary tuberculosis at the Turkish Military Chest Diseases Hospital, Istanbul, Turkey. No patients had taken antituberculosis drugs previously. The Bactec method was used to perform drug susceptibility testing for isoniazid, rifampicin, ethambutol, and streptomycin.
Primary resistance to one or more drugs was detected in 87 (23.8%) patients; resistance to isoniazid was most common (54 patients) followed by resistance to ethambutol (n = 39), rifampicin (n = 11), and streptomycin (n = 9). One-drug resistance was detected in 69 patients; two-drug resistance in 11, three-drug resistance in 6, and four-drug resistance in 1. Multidrug resistance (resistance to at least isoniazid and rifampicin) was detected in 10 patients. In logistic-regression analysis, primary drug resistance was associated with radiological advanced tuberculosis (p < 0.001).
Primary resistance to one or more drugs used in treating tuberculosis is relatively high. It is necessary to regularly screen for and treat drug resistance among those who live in close quarters, such as army barracks, school dormitories and prisons. Regular surveillance of drug sensitivity patterns should be maintained to determine appropriate alternate drug regimens and detect the spread of resistant stains in the population.
本研究旨在调查结核病的原发性耐药率。
我们评估了土耳其伊斯坦布尔土耳其军事胸科医院365例新诊断的肺结核培养阳性患者的临床资料、放射学特征和痰液样本。所有患者此前均未服用过抗结核药物。采用Bactec法对异烟肼、利福平、乙胺丁醇和链霉素进行药敏试验。
在87例（23.8%）患者中检测到对一种或多种药物的原发性耐药；对异烟肼的耐药最为常见（54例），其次是对乙胺丁醇（39例）、利福平（11例）和链霉素（9例）的耐药。69例患者检测到单药耐药；11例患者检测到两药耐药，6例患者检测到三药耐药，1例患者检测到四药耐药。10例患者检测到耐多药（至少对异烟肼和利福平耐药）。在逻辑回归分析中，原发性耐药与放射学上的晚期肺结核相关（p<0.001）。
结核病治疗中对一种或多种药物的原发性耐药率相对较高。有必要对生活在军营、学校宿舍和监狱等密集居住环境中的人群定期进行耐药筛查和治疗。应持续定期监测药敏模式，以确定合适的替代药物方案，并检测耐药菌株在人群中的传播。
