Javaid A, Hasan R, Zafar A, Ghafoor A, Pathan A J, Rab A, Sadiq A, Akram C M, Burki I, Shah K, Ansari M, Rizvi N, Khan S U, Awan S R, Syed Z A, Iqbal Z H, Shaheen Z, ur Rehman N
Department of Pulmonology, Postgraduate Medical Institute, Lady Reading Hospital Peshawar, Pakistan.
Int J Tuberc Lung Dis. 2008 Mar;12(3):326-31.
Pakistan ranks sixth in the world in terms of tuberculosis (TB) burden, with a World Health Organization estimated incidence of 181 per 100000, or 286000 new cases annually. Hospital-based data indicate a significant problem of multidrug-resistant TB (MDR-TB) in the country and highlight the need to assess its extent at community level. In this cross-sectional study, sputum samples from 742 untreated newly diagnosed pulmonary TB patients from all over the country were used.
To assess the prevalence of primary drug resistance in Pakistan.
Of 672 culture-positive patients, 76 (11.3%) showed resistance to one or more drugs. Resistance to streptomycin (10 microg/ml) was found in 36 (5.4%) patients, isoniazid (INH) (1 microg/ml) in 51 (7.6%), rifampicin (RMP) (5 microg/ml) in 15 (2.2%), ethambutol (10 microg/ml) in 12 (1.8%) and pyrazinamide in 22 (3.3%) samples. Forty-six (6.8%) of the isolates tested were resistant to a single drug, 10 (1.5%) to two drugs, 12 (1.8%) to three drugs, and 6 (0.9%) to four drugs, while 2 (0.3%) isolates were resistant to all five first-line agents. Primary MDR-TB was 1.8% (n=12) (INH 1 microg/ml, RMP 5 microg/ml).
The results of this study show a prevalence of primary MDR-TB in Pakistan of <2%, which needs to be addressed through an effective DOTS strategy.
巴基斯坦的结核病负担在全球排名第六，世界卫生组织估计其发病率为每10万人中有181例，即每年有286000例新发病例。基于医院的数据表明该国存在严重的耐多药结核病（MDR-TB）问题，并凸显了在社区层面评估其范围的必要性。在这项横断面研究中，使用了来自全国各地742名未经治疗的新诊断肺结核患者的痰液样本。
评估巴基斯坦原发性耐药的患病率。
在672例培养阳性患者中，76例（11.3%）对一种或多种药物耐药。对链霉素（10微克/毫升）耐药的患者有36例（5.4%），对异烟肼（INH）（1微克/毫升）耐药的有51例（7.6%），对利福平（RMP）（5微克/毫升）耐药的有15例（2.2%），对乙胺丁醇（10微克/毫升）耐药的有12例（1.8%），对吡嗪酰胺耐药的样本有22例（3.3%）。检测的分离株中有46例（6.8%）对单一药物耐药，10例（1.5%）对两种药物耐药，12例（1.8%）对三种药物耐药，6例（0.9%）对四种药物耐药，而2例（0.3%）分离株对所有五种一线药物均耐药。原发性MDR-TB为1.8%（n = 12）（INH 1微克/毫升，RMP 5微克/毫升）。
本研究结果显示巴基斯坦原发性MDR-TB的患病率<2%，需要通过有效的直接观察短程治疗（DOTS）策略来解决。
