Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA.
Lancet. 2011 Jan 8;377(9760):147-52. doi: 10.1016/S0140-6736(10)61972-1. Epub 2010 Dec 8.
Multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis have emerged as major global health threats. WHO recommends contact investigation in close contacts of patients with MDR and XDR tuberculosis. We aimed to assess the burden of tuberculosis disease in household contacts of such patients.
We undertook a retrospective cohort study of household contacts of patients treated for MDR or XDR tuberculosis in Lima, Peru, in 1996-2003. The primary outcome was active tuberculosis in household contacts at the time the index patient began MDR tuberculosis treatment and during the 4-year follow-up. We examined whether the occurrence of active tuberculosis in the household contacts differed by resistance pattern of the index patient: either MDR or XDR tuberculosis.
693 households of index patients with MDR tuberculosis were enrolled in the study. In 48 households, the Mycobacterium tuberculosis isolate from the index patient was XDR. Of the 4503 household contacts, 117 (2·60%) had active tuberculosis at the time the index patient began MDR tuberculosis treatment-there was no difference in prevalence between XDR and MDR tuberculosis households. During the 4-year follow-up, 242 contacts developed active tuberculosis-the frequency of active tuberculosis was nearly two times higher in contacts of patients with XDR tuberculosis than it was in contacts of patients with MDR tuberculosis (hazard ratio 1·88, 95% CI 1·10-3·21). In the 359 contacts with active tuberculosis, 142 (40%) had had isolates tested for resistance against first-line drugs, of whom 129 (90·9%, 95% CI 85·0-94·6) had MDR tuberculosis.
In view of the high risk of disease recorded in household contacts of patients with MDR or XDR tuberculosis, tuberculosis programmes should implement systematic household contact investigations for all patients identified as having MDR or XDR tuberculosis. If shown to have active tuberculosis, these household contacts should be suspected as having MDR tuberculosis until proven otherwise.
The Charles H Hood Foundation, the David Rockefeller Center for Latin American Studies at Harvard University, and the Bill & Melinda Gates Foundation.
耐多药（MDR）和广泛耐药（XDR）结核病已成为主要的全球卫生威胁。世卫组织建议对 MDR 和 XDR 结核病患者的密切接触者进行接触者调查。我们旨在评估此类患者的家庭接触者中结核病的负担。
我们对 1996 年至 2003 年在秘鲁利马接受 MDR 或 XDR 结核病治疗的患者的家庭接触者进行了回顾性队列研究。主要结局是在开始 MDR 结核病治疗时和 4 年随访期间家庭接触者中发生活动性结核病。我们检查了家庭接触者中活动性结核病的发生是否因索引患者的耐药模式而异：MDR 或 XDR 结核病。
共纳入 693 户 MDR 结核病患者家庭。在 48 户家庭中，从索引患者分离的结核分枝杆菌为 XDR。在 4503 名家庭接触者中，有 117 人（2.60%）在开始 MDR 结核病治疗时患有活动性结核病 - XDR 和 MDR 结核病家庭的患病率没有差异。在 4 年随访期间，242 名接触者发生活动性结核病 - XDR 结核病患者的接触者发生活动性结核病的频率几乎是 MDR 结核病患者的两倍（风险比 1.88，95%CI 1.10-3.21）。在 359 名患有活动性结核病的接触者中，有 142 人（40%）对一线药物的耐药性进行了检测，其中 129 人（90.9%，95%CI 85.0-94.6）患有 MDR 结核病。
鉴于 MDR 或 XDR 结核病患者的家庭接触者中记录的疾病风险很高，结核病规划应针对所有被确定为患有 MDR 或 XDR 结核病的患者实施系统的家庭接触者调查。如果这些家庭接触者被怀疑患有活动性结核病，应怀疑他们患有 MDR 结核病，除非另有证明。
查尔斯·H·胡德基金会、哈佛大学大卫·洛克菲勒拉丁美洲研究中心和比尔和梅琳达·盖茨基金会。
