Jeon Christie Y, Hwang Soo Hee, Min Jin Hong, Prevots D Rebecca, Goldfeder Lisa C, Lee Hyeyoung, Eum Seok Yong, Jeon Doo Soo, Kang Hyung Seok, Kim Jin Hee, Kim Byoung Ju, Kim Dae Yeon, Holland Steven M, Park Seung Kyu, Cho Sang Nae, Barry Clifton E, Via Laura E
Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA.
Clin Infect Dis. 2008 Jan 1;46(1):42-9. doi: 10.1086/524017.
Extensively drug-resistant (XDR) tuberculosis (TB) is a major public health threat in South Korea.
We analyzed baseline epidemiological data for 250 patients enrolled in an ongoing prospective observational study of TB at a large tertiary referral hospital in South Korea.
Twenty-six subjects with XDR TB were identified; all were patients who had previously received TB therapy. Cumulative previous treatment duration (range, 18-34 months; odds ratio [OR], 5.6; 95% confidence interval [CI], 1.0-59), number of previously received second-line anti-TB drugs (OR, 1.3; 95% CI, 1.1-1.5), and female sex (OR, 3.2; 95% CI, 1.1-8.3) were significantly associated with XDR TB in crude analyses. After controlling for other factors in a multivariable model, cumulative previous treatment duration remained significantly associated with XDR TB (OR, 5.8; 95% CI, 1.0-61). Subjects with XDR TB were more likely to produce culture-positive sputum at 6 months, compared with patients with non-multidrug resistant TB (risk ratio, 13; 95% CI, 5.1-53). Kanamycin resistance was found to be predictive of 6-month culture positivity after adjustment for ofloxacin and streptomycin resistance (risk ratio, 3.9; 95% CI, 1.9-11).
XDR TB was found to be associated with the cumulative duration of previous treatment with second-line TB drugs among subjects in a tertiary care TB hospital. Patients with XDR TB were more likely to not respond to therapy, and successful conversion of sputum culture results to negative was correlated with initial susceptibility to both fluoroquinolones and kanamycin but not to streptomycin.
广泛耐药结核病（XDR-TB）是韩国的一项重大公共卫生威胁。
我们分析了韩国一家大型三级转诊医院正在进行的结核病前瞻性观察研究中纳入的250例患者的基线流行病学数据。
共识别出26例XDR-TB患者；均为既往接受过抗结核治疗的患者。在粗分析中，既往累计治疗时长（范围18 - 34个月；比值比[OR]，5.6；95%置信区间[CI]，1.0 - 59）、既往接受二线抗结核药物的数量（OR，1.3；95% CI，1.1 - 1.5）以及女性（OR，3.2；95% CI，1.1 - 8.3）与XDR-TB显著相关。在多变量模型中控制其他因素后，既往累计治疗时长仍与XDR-TB显著相关（OR，5.8；95% CI，1.0 - 61）。与非耐多药结核病患者相比，XDR-TB患者在6个月时痰培养阳性的可能性更高（风险比，13；95% CI，5.1 - 53）。在调整氧氟沙星和链霉素耐药性后，发现卡那霉素耐药可预测6个月时的痰培养阳性（风险比，3.9；95% CI，1.9 - 11）。
在一家三级护理结核病医院的患者中，发现XDR-TB与既往使用二线抗结核药物的累计治疗时长相关。XDR-TB患者对治疗无反应的可能性更高，痰培养结果成功转阴与对氟喹诺酮类药物和卡那霉素的初始敏感性相关，而与链霉素无关。
