Hoopes Andrea J, Kammerer J Steve, Harrington Theresa A, Ijaz Kashef, Armstrong Lori R
Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Arch Intern Med. 2008 Oct 13;168(18):1984-92. doi: 10.1001/archinte.168.18.1984.
Seven percent of tuberculosis (TB) cases reported to the US National Tuberculosis Surveillance System in 2005 had Mycobacterium tuberculosis isolates with resistance to at least isoniazid.
We undertook this study to describe demographic characteristics, risk factor information, and treatment outcomes for persons with isoniazid-monoresistant (resistant to isoniazid and susceptible to rifampin, pyrazinamide, and ethambutol hydrochloride) TB compared with persons with TB susceptible to all first-line anti-TB drugs.
The numbers of isoniazid-monoresistant TB cases increased from 303 (4.1%) in 1993 to 351 (4.2%) in 2005. In our multivariate analysis of all TB cases reported from 1993 to 2003, the races/ethnicities of patients with isoniazid-monoresistant TB were significantly more likely to be US-born Asian/Pacific Islander (adjusted odds ratio [aOR], 1.9; 95% confidence interval [CI], 1.4-2.6), foreign-born Asian/Pacific Islander (1.8; 1.4-2.1), foreign-born black non-Hispanic (1.4; 1.1-1.7), or US-born Hispanic (1.3; 1.1-1.5). Isoniazid monoresistance was also associated with failure to complete therapy within 1 year (aOR, 1.7; 95% CI, 1.5-1.8), a history of TB (1.5; 1.3-1.7), and correctional facility residence (1.5; 1.2-1.7).
Isoniazid-monoresistant TB did not decline from January 1, 1993, through December 31, 2005, despite national downward trends observed in overall TB cases and in multidrug-resistant TB cases. Physicians must ensure completion of treatment for patients taking isoniazid as part of their TB or latent TB infection therapy. In addition, physicians should maintain heightened vigilance for isoniazid resistance when evaluating certain at-risk populations for TB and latent TB infection.
2005年向美国国家结核病监测系统报告的结核病（TB）病例中，7%的结核分枝杆菌分离株至少对异烟肼耐药。
我们开展本研究以描述对异烟肼单耐药（对异烟肼耐药但对利福平、吡嗪酰胺和盐酸乙胺丁醇敏感）的结核病患者与对所有一线抗结核药物敏感的结核病患者的人口统计学特征、危险因素信息及治疗结果。
异烟肼单耐药结核病病例数从1993年的303例（4.1%）增至2005年的351例（4.2%）。在我们对1993年至2003年报告的所有结核病病例的多变量分析中，异烟肼单耐药结核病患者的种族/族裔更有可能是在美国出生的亚裔/太平洋岛民（校正比值比[aOR]，1.9；95%置信区间[CI]，1.4 - 2.6）、外国出生的亚裔/太平洋岛民（1.8；1.4 - 2.1）、外国出生的非西班牙裔黑人（1.4；1.1 - 1.7）或在美国出生的西班牙裔（1.3；1.1 - 1.5）。异烟肼单耐药还与1年内未完成治疗（aOR，1.7；95% CI，1.5 - 1.8）、有结核病病史（1.5；1.3 - 1.7）以及居住在惩教机构（1.5；1.2 - 1.7）相关。
尽管总体结核病病例和耐多药结核病病例呈全国性下降趋势，但从1993年1月1日至2005年12月31日，异烟肼单耐药结核病并未减少。医生必须确保将异烟肼作为结核病或潜伏性结核感染治疗一部分的患者完成治疗。此外，医生在评估某些结核病和潜伏性结核感染高危人群时，应提高对异烟肼耐药的警惕性。
