Lu Po-Liang, Lee Yi-Whey, Peng Chien-Fang, Tsai Jih-Jin, Chen Yen-Hsu, Hwang Kao-Pin, Chen Tyen-Po
Department of Internal Medicine, Kaohsiung Medical University Hospital, 100 Shih-Chuan 1st Road, Kaohsiung, Taiwan, ROC.
Int J Antimicrob Agents. 2003 Mar;21(3):239-43. doi: 10.1016/s0924-8579(02)00353-9.
To investigate the anti-tuberculosis drug resistance pattern of pulmonary tuberculosis isolates in southern Taiwan, we performed a hospital-based surveillance at a southern Taiwan medical centre from 1996 to 2000. The combined drug resistance rates to at least one of four first-line agents (isoniazid, rifampicin, ethambutol, streptomycin) was 52.4%, and to both isoniazid and rifampicin was 11.4%, indicating high resistance rates compared with those reported in the World Health Organization (WHO)/International Union Against Tuberculosis and Lung Disease (IUATLD) global project and in northern Taiwan. The resistance rates to two second-line drugs, cycloserine, and kanamycin, were 75.7 and 23.7%, respectively. A significant decreasing trend in resistance rates to all tested drugs except streptomycin was observed during the 5-year period. The resistance rates in 1996 and 2000 were 43.1 and 16.4% for isoniazid, 23.4 and 9.5% for rifampicin, 23.4 and 12.1% for ethambutol, 92.7 and 50.9% for pyrazinamide. The combined drug resistance rate may not be the most accurate tool as it includes previously treated cases that may inflate the resistance rate and cases without a history of treatment. However, the observation of trends in the susceptibility of pulmonary tuberculosis with the increasing percentages of tuberculosis patients receiving the complete treatment course and the decreasing percentages of cases lost to follow-up in Kaohsiung after the institution of new governmental regulations for case management in 1997, suggest that such intervention programs are useful.
为调查台湾南部肺结核分离株的抗结核药物耐药模式，我们于1996年至2000年在台湾南部的一家医疗中心开展了一项基于医院的监测。对四种一线药物（异烟肼、利福平、乙胺丁醇、链霉素）中至少一种的联合耐药率为52.4%，对异烟肼和利福平两者的联合耐药率为11.4%，这表明与世界卫生组织（WHO）/国际抗结核和肺病联盟（IUATLD）全球项目及台湾北部报告的耐药率相比，耐药率较高。对两种二线药物环丝氨酸和卡那霉素的耐药率分别为75.7%和23.7%。在这5年期间，除链霉素外，对所有测试药物的耐药率均呈现显著下降趋势。1996年和2000年异烟肼的耐药率分别为43.1%和16.4%，利福平为23.4%和9.5%，乙胺丁醇为23.4%和12.1%，吡嗪酰胺为92.7%和50.9%。联合耐药率可能不是最准确的指标，因为它包括了可能使耐药率虚高的既往治疗病例以及无治疗史的病例。然而，观察到随着接受完整疗程治疗的肺结核患者百分比增加，以及1997年新的政府病例管理规定实施后高雄失访病例百分比下降，肺结核易感性呈现变化趋势，这表明此类干预项目是有用的。
