Kruijshaar Michelle E, Watson John M, Drobniewski Francis, Anderson Charlotte, Brown Timothy J, Magee John G, Smith E Grace, Story Alistair, Abubakar Ibrahim
Respiratory Diseases Department, Centre for Infections, Health Protection Agency, London NW9 5EQ.
BMJ. 2008 May 31;336(7655):1231-4. doi: 10.1136/bmj.39546.573067.25. Epub 2008 May 1.
To identify recent trends in, and factors associated with, resistance to antituberculosis drugs in England, Wales, and Northern Ireland.
Cohort of tuberculosis cases reported to the enhanced tuberculosis surveillance system matched to data on drug susceptibility and national strain typing data.
England, Wales, and Northern Ireland 1998-2005.
Unadjusted and adjusted odds ratios for drug resistance and associated factors. Proportion of multidrug resistant tuberculosis cases clustered.
28 620 culture confirmed cases were available for analysis. The proportion of cases resistant to isoniazid increased from 5% to 7%. Rifampicin resistance increased from 1.0% to 1.2% and multidrug resistance from 0.8% to 0.9%. Ethambutol and pyrazinamide resistance remained stable at around 0.4% and 0.6%, respectively. Regression analyses showed a significant increase in isoniazid resistance outside London (odds ratio 1.04, 95% confidence interval 1.01 to 1.07, a year, associated with changes in age (0.98, 0.98 to 0.99, a year), place of birth (1.49, 1.16 to 1.92), and ethnicity (P<0.05). In London, the rise (1.05, 1.02 to 1.08, a year) was related mainly to an ongoing outbreak. Increases in rifampicin resistance (1.06, 1.01 to 1.11, a year) and multidrug resistance (1.06, 1.00 to 1.12, a year) were small. A fifth of patients with multidrug resistant tuberculosis in 2004-5 had indistinguishable strain types, and one case was identified as extensively drug resistant.
The rise in isoniazid resistance reflects increasing numbers of patients from sub-Saharan Africa and the Indian subcontinent, who might have acquired resistance abroad, and inadequate control of transmission in London. The observed increases highlight the need for early case detection, rapid testing of susceptibility to drugs, and improved treatment completion.
确定英格兰、威尔士和北爱尔兰耐抗结核药物的近期趋势及相关因素。
向强化结核病监测系统报告的结核病病例队列，与药物敏感性数据和国家菌株分型数据相匹配。
1998 - 2005年的英格兰、威尔士和北爱尔兰。
耐药性及相关因素的未调整和调整比值比。耐多药结核病病例聚集的比例。
有28620例培养确诊病例可供分析。对异烟肼耐药的病例比例从5%增至7%。利福平耐药率从1.0%增至1.2%，耐多药率从0.8%增至0.9%。乙胺丁醇和吡嗪酰胺耐药率分别稳定在约0.4%和0.6%。回归分析显示，伦敦以外地区异烟肼耐药性显著增加（比值比1.04，95%置信区间1.01至1.07，每年），与年龄变化（0.98，0.98至0.99，每年）、出生地（1.49，1.16至1.92）和种族有关（P<0.05）。在伦敦，耐药性上升（1.05，1.02至1.08，每年）主要与持续的疫情爆发有关。利福平耐药性（1.06，1.01至1.11，每年）和耐多药率（1.06，1.00至1.12，每年）的增幅较小。2004 - 2005年，五分之一的耐多药结核病患者具有难以区分的菌株类型，且有1例被鉴定为广泛耐药。
异烟肼耐药性的上升反映出来自撒哈拉以南非洲和印度次大陆患者数量的增加，他们可能在国外已获得耐药性，以及伦敦对传播控制不足。观察到的耐药性增加凸显了早期病例发现、快速药敏检测和改善治疗完成情况的必要性。
