Eker Barbara, Ortmann Johannes, Migliori Giovanni B, Sotgiu Giovanni, Muetterlein Ralf, Centis Rosella, Hoffmann Harald, Kirsten Detlef, Schaberg Tom, Ruesch-Gerdes Sabine, Lange Christoph
Research Center Borstel, Borstel, Germany.
Emerg Infect Dis. 2008 Nov;14(11):1700-6. doi: 10.3201/eid1411.080729.
We evaluated risk factors and treatment outcomes associated with multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) in Germany in 2004-2006. In 177 (4%) of 4,557 culture-positive TB cases, Mycobacterium tuberculosis isolates were identified as MDR TB; an additional 7 (0.15%) met criteria for XDR TB. Of these 184 patients, 148 (80%) were born in countries of the former Soviet Union. In patients with XDR TB, hospitalization was longer (mean +/- SD 202 +/- 130 vs. 123 +/- 81 days; p = 0.015) and resistance to all first-line drugs was more frequent (36% vs. 86%; p = 0.013) than in patients with MDR TB. Seventy-four (40%) of these 184 patients received treatment with linezolid. Treatment success rates ranged from 59% for the entire cohort (59% for MDR TB and 57% for XDR TB) to 87% for those with a definitive outcome (n = 125; 89% for MDR TB and 80% for XDR TB). Extensive drug susceptibility testing and availability of second- and third-line drugs under inpatient management conditions permit relatively high treatment success rates in MDR- and XDR TB.
我们评估了2004 - 2006年德国耐多药（MDR）和广泛耐药（XDR）结核病（TB）的危险因素及治疗结果。在4557例培养阳性的结核病病例中，有177例（4%）结核分枝杆菌分离株被鉴定为耐多药结核病；另有7例（0.15%）符合广泛耐药结核病的标准。在这184例患者中，148例（80%）出生于前苏联国家。与耐多药结核病患者相比，广泛耐药结核病患者的住院时间更长（平均±标准差：202±130天 vs. 123±81天；p = 0.015），对所有一线药物的耐药情况更常见（36% vs. 86%；p = 0.013）。这184例患者中有74例（40%）接受了利奈唑胺治疗。治疗成功率范围为：整个队列59%（耐多药结核病为59%，广泛耐药结核病为57%），至有明确结果者87%（n = 125；耐多药结核病为89%，广泛耐药结核病为80%）。在住院管理条件下进行广泛的药敏试验以及二线和三线药物的可及性使得耐多药和广泛耐药结核病的治疗成功率相对较高。
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