Department of Internal Medicine, Saint John Regional Hospital, Saint John, New Brunswick, Canada.
Int J Tuberc Lung Dis. 2010 Feb;14(2):217-22.
Alberta, Canada, 1990-2003.
Monotherapy of active tuberculosis (TB) promotes drug resistance. Given the common practice of empiric fluoroquinolone (FQ) therapy for urinary tract infections (UTI) and frequent delayed diagnosis of renal TB, we assessed urine Mycobacterium tuberculosis isolates for FQ resistance.
Retrospective study. Urine M. tuberculosis isolates underwent FQ susceptibility testing. Records were reviewed for evidence of FQ exposure and diagnostic delay.
Among 78 culture-positive renal TB patients between 1990 and 2003, initial isolates of M. tuberculosis were available from 74 (94.9%). Three (4.1%) were FQ-resistant. Previous FQ use was confirmed in nine cases (12.2%). FQ-exposed isolates were more likely than non-exposed isolates to be FQ-resistant (2/9, 22.2% vs. 1/65, 1.5%, P = 0.037). Among 41 cases (55.4%) with signs or symptoms of UTI, eight (19.5%) had previous FQ exposure, of which seven (87.5%) had delayed diagnosis. Only 15/33 (45.5%) UTI symptomatic cases without prior FQ exposure had delayed diagnosis (P = 0.050). In 2/8 (25%) UTI symptomatic cases with prior FQ exposure, the M. tuberculosis isolate was FQ-resistant.
FQ monotherapy of unsuspected renal TB may delay diagnosis and lead to FQ resistance.
加拿大艾伯塔省，1990-2003 年。
结核病（TB）的单药治疗会促进耐药性的产生。鉴于氟喹诺酮（FQ）经验性治疗尿路感染（UTI）的常见做法以及肾脏结核的频繁延迟诊断，我们评估了尿液分枝杆菌结核分离株对 FQ 的耐药性。
回顾性研究。对尿液分枝杆菌结核分离株进行 FQ 药敏试验。对记录进行了回顾，以评估 FQ 暴露和诊断延迟的证据。
1990 年至 2003 年间，78 例培养阳性的肾结核患者中，74 例（94.9%）的初始分枝杆菌结核分离株可获得。其中 3 例（4.1%）对 FQ 耐药。在 9 例（12.2%）中证实了既往 FQ 使用。FQ 暴露分离株比非暴露分离株更有可能对 FQ 耐药（2/9，22.2%比 1/65，1.5%，P = 0.037）。在 41 例（55.4%）有 UTI 体征或症状的病例中，有 8 例（19.5%）有既往 FQ 暴露，其中 7 例（87.5%）有延迟诊断。仅有 15/33（45.5%）无 FQ 暴露史的 UTI 症状病例有延迟诊断（P = 0.050）。在 2/8（25%）有既往 FQ 暴露的 UTI 症状病例中，分枝杆菌结核分离株对 FQ 耐药。
对未怀疑的肾结核进行 FQ 单药治疗可能会延迟诊断并导致 FQ 耐药。
