Bang Didi, Lillebaek Troels, Thomsen Vibeke Østergaard, Andersen Ase Bengård
National Centre for Antimicrobials and Infection Control, Statens Serum Institut, Copenhagen, Denmark.
Scand J Infect Dis. 2010 Apr;42(4):288-93. doi: 10.3109/00365540903456282.
A retrospective nationwide study including all culture-verified multidrug-resistant (MDR) tuberculosis (TB) cases was performed in Denmark. The aim was to examine the long-term treatment outcome of MDR-TB, to assess if MDR-TB transmission occurs, and to evaluate a rapid mutation analysis detecting rifampin and isoniazid resistance in this cohort. Clinical data were obtained from patient records. A restriction fragment length polymorphism genotype database of all TB cases was compared for identical strains indicating active transmission. Twenty-nine cases of MDR-TB were identified and the incidence was low at 0.5%. Acquired MDR-TB and active transmission was rare. Mutations in rifampin (rpoB) and isoniazid (katG, inhA) genes correctly determined resistance in 100% and 82% of all isolates tested, respectively. Initial treatment success was 89% for 27 MDR-TB patients with available outcome data. Initially 3 patients defaulted; no deaths were reported. Including successfully re-treated default patients and censoring patients who spent <2 y in the cohort, long-term treatment success was achieved for all 26 patients (mean follow-up 8.9 y). MDR-TB has a good prognosis in the high-income, low TB burden country of Denmark. Continued surveillance and rapid detection of resistance mutations directly in smear-positive patients may improve the standard of MDR-TB care.
丹麦开展了一项全国性回顾性研究，纳入了所有经培养确诊的耐多药结核病（MDR-TB）病例。目的是研究耐多药结核病的长期治疗结果，评估耐多药结核病是否会发生传播，并在该队列中评估一种检测利福平和异烟肼耐药性的快速突变分析方法。临床数据从患者记录中获取。比较了所有结核病病例的限制性片段长度多态性基因型数据库，以找出表明有传播的相同菌株。共识别出29例耐多药结核病病例，发病率较低，为0.5%。获得性耐多药结核病和传播情况很少见。利福平（rpoB）基因和异烟肼（katG、inhA）基因的突变分别在所有检测分离株中100%和82%的情况下正确确定了耐药性。对于27例有可用结局数据的耐多药结核病患者，初始治疗成功率为89%。最初有3例患者失访；未报告死亡病例。将成功重新治疗的失访患者以及在队列中停留时间<2年的删失患者纳入后，26例患者均取得了长期治疗成功（平均随访8.9年）。在丹麦这个高收入、低结核病负担的国家，耐多药结核病的预后良好。持续监测并直接在涂片阳性患者中快速检测耐药突变可能会提高耐多药结核病的治疗水平。
