Keshavjee Salmaan, Gelmanova Irina Y, Farmer Paul E, Mishustin Sergey P, Strelis Aivar K, Andreev Yevgeny G, Pasechnikov Alexander D, Atwood Sidney, Mukherjee Joia S, Rich Michael L, Furin Jennifer J, Nardell Edward A, Kim Jim Y, Shin Sonya S
Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
Lancet. 2008 Oct 18;372(9647):1403-9. doi: 10.1016/S0140-6736(08)61204-0. Epub 2008 Aug 22.
Mycobacterium tuberculosis strains that cause untreatable drug-resistant disease are a threat worldwide. We describe the treatment, management, and outcomes of patients with extensively drug-resistant tuberculosis in Tomsk, Russia.
We undertook a retrospective cohort study of 608 patients with multidrug resistant tuberculosis who had treatment in civilian or prison services, between Sept 10, 2000, and Nov 1, 2004, according to the treatment strategy recommended by WHO. Clinical characteristics, management practices, and treatment outcomes of patients with extensively drug-resistant (XDR) tuberculosis and non-extensively drug-resistant (non-XDR) tuberculosis are described. The main outcome was the frequency of poor and favourable outcomes at the end of treatment.
Of 608 patients with multidrug resistant tuberculosis, 29 (4.8%) patients had baseline XDR tuberculosis. Treatment failure was more common in patients with XDR tuberculosis than in those with non-XDR tuberculosis (31%vs 8.5%, p=0.0008). 48.3% of patients with XDR tuberculosis and 66.7% of patients with non-XDR tuberculosis had treatment cure or completion (p=0.04). The frequency and management of adverse events did not differ between patients with XDR and non-XDR tuberculosis.
The chronic features of tuberculosis in these patients suggest that extensively drug-resistant tuberculosis may be acquired through previous treatments that include second-line drugs. Aggressive management of this infectious disease is feasible and can prevent high mortality rates and further transmission of drug-resistant strains of Mycobacterium tuberculosis.
导致无法治疗的耐药疾病的结核分枝杆菌菌株在全球构成威胁。我们描述了俄罗斯托木斯克地区广泛耐药结核病患者的治疗、管理及转归情况。
我们对2000年9月10日至2004年11月1日期间，根据世界卫生组织推荐的治疗策略，在民用或监狱医疗机构接受治疗的608例耐多药结核病患者进行了一项回顾性队列研究。描述了广泛耐药（XDR）结核病患者和非广泛耐药（非XDR）结核病患者的临床特征、管理措施及治疗转归。主要结局是治疗结束时不良和良好结局的发生率。
在608例耐多药结核病患者中，29例（4.8%）患者基线时患有XDR结核病。XDR结核病患者的治疗失败比非XDR结核病患者更常见（31%对8.5%，p = 0.0008）。48.3%的XDR结核病患者和66.7%的非XDR结核病患者治疗治愈或完成（p = 0.04）。XDR和非XDR结核病患者不良事件的发生率和管理情况无差异。
这些患者结核病的慢性特征提示，广泛耐药结核病可能是通过既往包括二线药物的治疗获得的。积极管理这种传染病是可行的，并且可以预防高死亡率及结核分枝杆菌耐药菌株的进一步传播。
