Dewan P, Sosnovskaja A, Thomsen V, Cicenaite J, Laserson K, Johansen I, Davidaviciene E, Wells C
Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Int J Tuberc Lung Dis. 2005 Feb;9(2):170-4.
Nations of the former Soviet Union have the world's highest reported levels of resistance to anti-tuberculosis drugs. We conducted the first national survey of anti-tuberculosis drug resistance in the Republic of Lithuania.
We tested Mycobacterium tuberculosis isolates from all incident culture-positive pulmonary TB patients registered in 2002. New patients were those treated for <1 month with any first-line anti-tuberculosis drug (isoniazid [INH], rifampin [RMP], ethambutol, or streptomycin); previously treated patients were those treated for > or =1 month.
Of 1163 isolates, 475 (41%) were resistant to at least one first-line drug, and 263 (23%) were resistant to at least INH and RMP (MDR); this included 76/818 (9.3%) from new patients and 187/345 (54%) from previously treated patients. Of 52 MDR isolates randomly selected for extended testing at an international reference laboratory, 27 (51%, 95%CI 38-66) had resistance to pyrazinamide, 21 (40%, 95%CI 27-55) to kanamycin, and 9 (17%, 95%CI 8-30) to ofloxacin.
The prevalence of MDR-TB in Lithuania is among the world's highest. Among MDR-TB isolates, aminoglycoside and fluoroquinolone resistance were common. To combat drug-resistant TB, Lithuania has implemented the WHO global TB control strategy (DOTS), and is developing an MDR-TB treatment program (DOTS-Plus).
据报道，前苏联国家的抗结核药物耐药水平位居世界之首。我们对立陶宛共和国进行了首次全国性抗结核药物耐药性调查。
我们对2002年登记的所有新确诊的痰涂片阳性肺结核患者的结核分枝杆菌分离株进行了检测。新患者是指接受任何一线抗结核药物（异烟肼[INH]、利福平[RMP]、乙胺丁醇或链霉素）治疗不足1个月的患者；既往治疗过的患者是指接受治疗≥1个月的患者。
在1163株分离株中，475株（41%）对至少一种一线药物耐药，263株（23%）对至少INH和RMP耐药（耐多药）；其中包括新患者中的76/818（9.3%）和既往治疗过的患者中的187/345（54%）。在随机选择送往国际参考实验室进行进一步检测的52株耐多药分离株中，27株（51%，95%CI 38 - 66）对吡嗪酰胺耐药，21株（40%，95%CI 27 - 55）对卡那霉素耐药，9株（17%，95%CI 8 - 30）对氧氟沙星耐药。
立陶宛耐多药结核病的患病率位居世界前列。在耐多药结核分离株中，氨基糖苷类和氟喹诺酮类耐药很常见。为应对耐药结核病，立陶宛已实施世界卫生组织全球结核病控制策略（直接观察短程化疗），并正在制定耐多药结核病治疗方案（强化版直接观察短程化疗）。
