Molecular Epidemiology Division, The Research Institute of Tuberculosis/Japan Anti-Tuberculosis Association, Matsuyama, Tokyo, Japan.
Emerg Infect Dis. 2010 Jun;16(6):948-54. doi: 10.3201/eid1606.091844.
The emergence and spread of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) has raised public health concern about global control of TB. To estimate the transmission dynamics of MDR and XDR TB, we conducted a DNA fingerprinting analysis of 55 MDR/XDR Mycobacterium tuberculosis strains isolated from TB patients throughout Japan in 2002. Twenty-one (38%) of the strains were classified into 9 clusters with geographic links, which suggests that community transmission of MDR/XDR TB is ongoing. Furthermore, the XDR M. tuberculosis strains were more likely than the non-XDR MDR strains to be clustered (71% vs. 24%; p = 0.003), suggesting that transmission plays a critical role in the new incidence of XDR TB. These findings highlight the difficulty of preventing community transmission of XDR TB by conventional TB control programs and indicate an urgent need for a more appropriate strategy to contain highly developed drug-resistant TB.
耐多药（MDR）和广泛耐药（XDR）结核病（TB）的出现和传播引起了全球对结核病控制的公共卫生关注。为了估计 MDR 和 XDR 结核分枝杆菌的传播动态，我们对 2002 年日本各地结核病患者分离的 55 株 MDR/XDR 结核分枝杆菌进行了 DNA 指纹分析。21 株（38%）菌株分为 9 个具有地理联系的簇，这表明 MDR/XDR 结核分枝杆菌的社区传播正在进行。此外，XDR 结核分枝杆菌菌株比非 XDR MDR 菌株更有可能聚类（71%比 24%；p=0.003），这表明传播在 XDR TB 的新发病例中起着关键作用。这些发现突出了传统结核病控制方案难以预防 XDR TB 的社区传播，并表明迫切需要采取更合适的策略来控制高度耐药的结核病。
