Shah N Sarita, Pratt Robert, Armstrong Lori, Robison Valerie, Castro Kenneth G, Cegielski J Peter
Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, 1600 Clifton Rd, Mailstop E-10, Atlanta, GA 30333, USA.
JAMA. 2008 Nov 12;300(18):2153-60. doi: 10.1001/jama.300.18.2153.
Worldwide emergence of extensively drug-resistant tuberculosis (XDR-TB) has raised global public health concern, given the limited therapy options and high mortality.
To describe the epidemiology of XDR-TB in the United States and to identify unique characteristics of XDR-TB cases compared with multidrug-resistant TB (MDR-TB) and drug-susceptible TB cases.
DESIGN, SETTING, AND PATIENTS: Descriptive analysis of US TB cases reported from 1993 to 2007. Extensively drug-resistant TB was defined as resistance to isoniazid, a rifamycin, a fluoroquinolone, and at least 1 of amikacin, kanamycin, or capreomycin based on drug susceptibility test results from initial and follow-up specimens.
Extensively drug-resistant TB case counts and trends, risk factors for XDR-TB, and overall survival.
A total of 83 cases of XDR-TB were reported in the United States from 1993 to 2007. The number of XDR-TB cases declined from 18 (0.07% of 25 107 TB cases) in 1993 to 2 (0.02% of 13 293 TB cases) in 2007, reported to date. Among those with known human immunodeficiency virus (HIV) test results, 31 (53%) were HIV-positive. Compared with MDR-TB cases, XDR-TB cases were more likely to have disseminated TB disease (prevalence ratio [PR], 2.06; 95% confidence interval [CI], 1.19-3.58), less likely to convert to a negative sputum culture (PR, 0.55; 95% CI, 0.33-0.94), and had a prolonged infectious period (median time to culture conversion, 183 days vs 93 days for MDR-TB; P < .001). Twenty-six XDR-TB cases (35%) died during treatment, of whom 21 (81%) were known to be HIV-infected. Mortality was higher among XDR-TB cases than among MDR-TB cases (PR, 1.82; 95% CI, 1.10-3.02) and drug-susceptible TB cases (PR, 6.10; 95% CI, 3.65-10.20).
Although the number of US XDR-TB cases has declined since 1993, coinciding with improved TB and HIV/AIDS control, cases continue to be reported each year.
鉴于治疗选择有限且死亡率高，广泛耐药结核病（XDR-TB）在全球范围内的出现引发了全球公共卫生关注。
描述美国XDR-TB的流行病学特征，并确定XDR-TB病例与耐多药结核病（MDR-TB）和药物敏感结核病病例相比的独特特征。
设计、地点和患者：对1993年至2007年美国报告的结核病病例进行描述性分析。根据初始和随访标本的药敏试验结果，广泛耐药结核病被定义为对异烟肼、一种利福霉素、一种氟喹诺酮以及阿米卡星、卡那霉素或卷曲霉素中的至少一种耐药。
广泛耐药结核病病例数及趋势、XDR-TB的危险因素和总体生存率。
1993年至2007年美国共报告83例XDR-TB病例。截至目前，XDR-TB病例数从1993年的18例（占25107例结核病病例的0.07%）降至2007年的2例（占13293例结核病病例的0.02%）。在已知人类免疫缺陷病毒（HIV）检测结果的患者中，31例（53%）为HIV阳性。与MDR-TB病例相比，XDR-TB病例更易发生播散性结核病（患病率比[PR]，2.06；95%置信区间[CI]，1.19 - 3.58），痰培养转阴的可能性较小（PR，0.55；95%CI，0.33 - 0.94），且传染期延长（培养转阴的中位时间，XDR-TB为183天，MDR-TB为93天；P <.001）。26例XDR-TB病例（35%）在治疗期间死亡，其中21例（81%）已知感染HIV。XDR-TB病例的死亡率高于MDR-TB病例（PR，1.82；95%CI，1.10 - 3.02）和药物敏感结核病病例（PR，6.10；95%CI，3.65 - 10.20）。
尽管自1993年以来美国XDR-TB病例数有所下降，这与结核病和HIV/AIDS控制的改善相吻合，但每年仍有病例报告。
