Cohen Ted, Colijn Caroline, Wright Abigail, Zignol Matteo, Pym Alexander, Murray Megan
Division of Social Medicine and Health Inequalities, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
Am J Respir Crit Care Med. 2008 Jun 15;177(12):1302-6. doi: 10.1164/rccm.200801-175PP. Epub 2008 Mar 27.
The International Union Against Tuberculosis and Lung Disease/World Health Organization Global Project on Anti-Tuberculosis Drug Resistance Surveillance recently released the fourth global survey, which documents the highest burden of multidrug-resistant tuberculosis (TB) yet reported. The best estimate of the number of new cases of multidrug-resistant disease occurring in 2006 is close to half a million and the recent recognition of extensively drug-resistant TB underscores the need for expanded surveillance, especially in areas in which TB control programs have been compromised by an escalating burden of TB and HIV. We review current methods used for drug resistance surveillance and describe methodologic obstacles for estimating the true extent of the problem, particularly in settings where HIV/TB coinfection is common or where a substantial portion of TB cases are treated in the private sector. We highlight practical challenges to the validity of surveillance studies and discuss how additional investment in laboratory capacity, diagnostic technologies, and sentinel site surveillance can improve our ability to estimate of the burden of drug-resistant TB.
国际防痨和肺部疾病联盟/世界卫生组织全球抗结核药物耐药性监测项目近期发布了第四次全球调查，该调查记录了迄今所报告的多重耐药结核病负担最高的情况。2006年发生的耐多药疾病新病例数的最佳估计接近50万，最近对广泛耐药结核病的认识突出了扩大监测的必要性，特别是在结核病控制项目因结核病和艾滋病毒负担不断加重而受到损害的地区。我们回顾了目前用于耐药性监测的方法，并描述了估计问题真实程度的方法学障碍，特别是在艾滋病毒/结核病合并感染常见或相当一部分结核病病例在私营部门接受治疗的环境中。我们强调了监测研究有效性面临的实际挑战，并讨论了在实验室能力、诊断技术和哨点监测方面增加投资如何能够提高我们估计耐药结核病负担的能力。
