Moniruzzaman A, Elwood R K, Schulzer M, FitzGerald J M
Department of Health Care and Epidemiology, University of British Columbia, Vancouver, British Columbia, Canada.
Int J Tuberc Lung Dis. 2006 Aug;10(8):844-50.
Provincial tuberculosis (TB) services, British Columbia, Canada.
To estimate the risk of drug resistance among foreign-born TB patients and to identify risk factors associated with drug resistance.
Using the provincial TB database, we examined all culture-positive foreign-born TB patients for the years 1990-2001. The risk of having a drug-resistant isolate was estimated according to country and region of origin.
Of 1940 foreign-born patients identified, 247 (12.7%, 95%CI 11.3-14.3) cases had isolates resistant to at least one of the first-line drugs, with 160 (8.3%) isolates showing monoresistance, 24 (1.2%) multidrug resistance (resistance to at least isoniazid and rifampin) and 63 (3.3%) polyresistance (resistance to two or more drugs, excluding MDR). Country-specific analysis showed that immigrants from Vietnam (adjusted OR 2.12, 95%CI 1.37-3.27) and the Philippines (adjusted OR 1.71, 95%CI 1.10-2.66) had a significantly higher risk of resistance than other immigrants. In addition, the risk was the highest for younger TB patients and patients with reactivated disease (adjusted OR 2.12, 95%CI 1.09-4.09).
The risk of drug resistance was the highest among foreign-born patients from Vietnam and the Philippines. These findings should assist clinicians in prescribing and tailoring anti-tuberculosis regimens for immigrants more appropriately.
加拿大不列颠哥伦比亚省省级结核病服务机构。
评估出生在国外的结核病患者的耐药风险，并确定与耐药相关的风险因素。
利用省级结核病数据库，我们调查了1990 - 2001年所有培养阳性的出生在国外的结核病患者。根据原籍国和地区估计有耐药菌株的风险。
在1940名确定的出生在国外的患者中，247例（12.7%，95%可信区间11.3 - 14.3）的菌株对至少一种一线药物耐药，其中160例（8.3%）为单耐药，24例（1.2%）为多耐药（对至少异烟肼和利福平耐药），63例（3.3%）为多药耐药（对两种或更多药物耐药，不包括耐多药）。国别分析显示，来自越南的移民（调整后比值比2.12，95%可信区间1.37 - 3.27）和菲律宾的移民（调整后比值比1.71，95%可信区间1.10 - 2.66）的耐药风险显著高于其他移民。此外，年轻结核病患者和复发疾病患者的风险最高（调整后比值比2.12，95%可信区间1.09 - 4.09）。
来自越南和菲律宾的出生在国外的患者耐药风险最高。这些发现应有助于临床医生更恰当地为移民开抗结核治疗方案并进行调整。
