耐药肺结核的耐药模式。

Resistance pattern in drug-resistant pulmonary tuberculosis.

作者信息

Nagaraja C, Shashibhushan B L, Sagar C, Asif M, Manjunath P H

机构信息

Department of Pulmonary Medicine, Rajiv Gandhi Institute of Chest Diseases, BMCRI, Bangalore, Karnataka, India.

出版信息

J Postgrad Med. 2011 Jul-Sep;57(3):181-3. doi: 10.4103/0022-3859.85197.

DOI:10.4103/0022-3859.85197

PMID:21941053

Abstract

BACKGROUND

Drug-resistant tuberculosis is an important issue for public health. There is a rise in the trend of drug-resistant tuberculosis, especially multi drug resistance (MDR), in different parts of world, India being one of the high burden countries. This study is undertaken to assess the various patterns of resistance among confirmed drug resistant pulmonary tubercular patients and to initiate second line anti tubercular treatment.

AIMS AND OBJECTIVES

To assess various resistance patterns among confirmed drug resistant pulmonary tubercular patients and for the initiation of appropriate drug regimens in our setup.

STUDY DESIGN

An observational prospective study.

MATERIALS AND METHODS

This study was conducted at Rajiv Gandhi Institute of Chest Diseases, Bangalore between January 2005 and November 2010. A total of 309 drug resistant tuberculosis cases were studied. Sputum culture and drug sensitivity were carried out at National Tuberculosis Institute. Drug sensitivity testing done for all first line drugs, except pyrazinamide, by using LJ media.

RESULTS

In this study, out of 309 patients, MDR pattern was observed in 224 (72%), of which 20 (6.47%) had resistance only to isoniazid (INH) and rifampicin (RMP), 58 (18.7%) had resistance to INH, RMP, and either of the other first line drugs streptomycinor ethambutol and 146 (47.25%) had resistance to all first line drugs. Poly drug resistance pattern was observed in 72 (23.3%) and Mono drug resistance in 13 (4.2%).

CONCLUSION

In the present study the most common pattern observed is MDR with predominant resistance to INH. There is a rise in the number of drug resistant tuberculosis cases, especially MDR. Hence close monitoring of drug resistant pattern is required to formulate designs of different regimens in the treatment of drug resistant tuberculosis; especially MDR-TB based on accredited laboratory reports, in a specialized center which is very much essential for the betterment of the patients and the community.

摘要

背景

耐药结核病是一个重要的公共卫生问题。在世界不同地区，耐药结核病，尤其是多重耐药（MDR）的趋势呈上升态势，印度是高负担国家之一。本研究旨在评估确诊的耐药肺结核患者的各种耐药模式，并启动二线抗结核治疗。

目的

评估确诊的耐药肺结核患者的各种耐药模式，并在我们的机构中启动适当的药物治疗方案。

研究设计

一项观察性前瞻性研究。

材料与方法

本研究于2005年1月至2010年11月在班加罗尔的拉吉夫·甘地胸科研究所进行。共研究了309例耐药结核病病例。痰培养和药敏试验在国家结核病研究所进行。除吡嗪酰胺外，所有一线药物均采用LJ培养基进行药敏试验。

结果

在本研究的309例患者中，观察到224例（72%）为MDR模式，其中20例（6.47%）仅对异烟肼（INH）和利福平（RMP）耐药，58例（18.7%）对INH、RMP以及其他一线药物链霉素或乙胺丁醇中的一种耐药，146例（47.25%）对所有一线药物耐药。观察到72例（23.3%）为多药耐药模式，13例（4.2%）为单药耐药模式。