Wright Abigail, Zignol Matteo, Van Deun Armand, Falzon Dennis, Gerdes Sabine Ruesch, Feldman Knut, Hoffner Sven, Drobniewski Francis, Barrera Lucia, van Soolingen Dick, Boulabhal Fadila, Paramasivan C N, Kam Kai Man, Mitarai Satoshi, Nunn Paul, Raviglione Mario
Stop TB Department, WHO, Geneva, Switzerland.
Lancet. 2009 May 30;373(9678):1861-73. doi: 10.1016/S0140-6736(09)60331-7. Epub 2009 Apr 15.
The Global Project on Anti-Tuberculosis Drug Resistance has been gathering data since 1994. This study provides the latest data on the extent of drug resistance worldwide.
Data for drug susceptibility were gathered from 90 726 patients in 83 countries and territories between 2002 and 2007. Standardised collection of results enabled comparison both between and within countries. Where possible, data for HIV status and resistance to second-line drugs were also obtained. Laboratory data were quality assured by the Supranational Tuberculosis Reference Laboratory Network.
The median prevalence of resistance to any drug in new cases of tuberculosis was 11.1% (IQR 7.0-22.3). The prevalence of multidrug resistance in new tuberculosis cases ranged from 0% in eight countries to 7% in two provinces in China, 11.1% in Northern Mariana Islands (although reporting only two cases), and between 6.8% and 22.3% in nine countries of the former Soviet Union, including 19.4% in Moldova and 22.3% in Baku, Azerbaijan (median for countries surveyed 1.6%, IQR 0.6-3.9). Trend analysis showed that between 1994 and 2007, the prevalence of multidrug-resistant (MDR) tuberculosis in new cases increased substantially in South Korea and in Tomsk Oblast and Orel Oblast, Russia, but was stable in Estonia and Latvia. The prevalence of MDR tuberculosis in all tuberculosis cases decreased in Hong Kong and the USA. 37 countries and territories reported representative data on extensively drug-resistant (XDR) tuberculosis. Five countries, all from the former Soviet Union, reported 25 cases or more of XDR tuberculosis each, with prevalence among MDR-tuberculosis cases ranging between 6.6% and 23.7%.
MDR tuberculosis remains a threat to tuberculosis control in provinces in China and countries of the former Soviet Union. Data on drug resistance are unavailable in many countries, especially in Africa, emphasising the need to develop easier methods for surveillance of resistance in tuberculosis.
Global Project: United States Agency for International Development and Eli Lilly and Company. Drug resistance surveys: national tuberculosis programmes, the Government of the Netherlands, the Global Fund to Fight AIDS, Tuberculosis and Malaria, Japan International Cooperation Agency, and Kreditanstalt für Wiederaufbau.
全球抗结核药物耐药性项目自1994年起开始收集数据。本研究提供了全球耐药程度的最新数据。
收集了2002年至2007年间83个国家和地区90726例患者的药物敏感性数据。标准化的结果收集方式使得不同国家之间以及国家内部都能够进行比较。在可能的情况下，还获取了艾滋病病毒感染状况和对二线药物耐药性的数据。实验室数据由跨国结核病参比实验室网络进行质量保证。
结核病新发病例中对任意一种药物耐药的患病率中位数为11.1%（四分位间距7.0 - 22.3）。新结核病病例中的耐多药患病率在8个国家为0%，在中国的两个省份为7%，在北马里亚纳群岛为11.1%（尽管仅报告了2例），在前苏联的9个国家中为6.8%至22.3%，其中摩尔多瓦为19.4%，阿塞拜疆巴库为22.3%（所调查国家的中位数为1.6%，四分位间距0.6 - 3.9）。趋势分析表明，1994年至2007年间，韩国以及俄罗斯的托木斯克州和奥廖尔州新发病例中的耐多药结核病患病率大幅上升，但在爱沙尼亚和拉脱维亚保持稳定。香港和美国所有结核病病例中的耐多药结核病患病率有所下降。37个国家和地区报告了广泛耐药结核病的代表性数据。5个国家（均来自前苏联）各自报告了25例或更多的广泛耐药结核病病例，耐多药结核病病例中的患病率在6.6%至23.7%之间。
耐多药结核病仍然对中国各省份以及前苏联国家的结核病控制构成威胁。许多国家，尤其是非洲国家，缺乏耐药性数据，这凸显了开发更简便的结核病耐药性监测方法的必要性。
全球项目：美国国际开发署和礼来公司。耐药性调查：各国结核病规划、荷兰政府、全球抗击艾滋病、结核病和疟疾基金、日本国际协力机构以及德国复兴信贷银行。
