Victorian Infectious Diseases Service, Royal Melbourne Hospital and Department of Medicine, University of Melbourne, Parkville, Victoria, Australia.
Int J Tuberc Lung Dis. 2012 Oct;16(10):1320-5. doi: 10.5588/ijtld.12.0092. Epub 2012 Aug 3.
The effectiveness of public health strategies following exposure to multidrug-resistant tuberculosis (MDR-TB) is not clear.
To perform long-term follow-up of MDR-TB contacts and review individual outcomes and management approaches.
Retrospective review of MDR-TB contacts identified by the Victorian Department of Health from 1995 to 2010. Health records, including personal medical and pharmacy records and statewide clinical and laboratory TB databases, were searched to identify management strategies and individual outcomes.
A total of 570 contacts of 47 MDR-TB cases were identified, with a total follow-up period of 3093 person-years of observation (PYO) since exposure. Of 570 contacts, 49 (8.6%) were considered likely to have been infected with Mycobacterium tuberculosis from index cases, and 11/49 (22.5%) of these were prescribed preventive therapy tailored to isolate susceptibility. No MDR-TB cases occurred in those receiving preventive treatment, while two cases were observed in those not treated (incidence 2878/100 000 PYO during the first 2 years post exposure).
The risk of MDR-TB transmission to close contacts in this low-prevalence setting highlights the potential for public health strategies involving preventive treatment.
接触耐多药结核病（MDR-TB）后公共卫生策略的效果尚不清楚。
对 MDR-TB 接触者进行长期随访，并回顾个体结局和管理方法。
回顾性分析 1995 年至 2010 年期间维多利亚州卫生部确定的 MDR-TB 接触者。查阅健康记录，包括个人医疗和药房记录以及全州临床和实验室结核病数据库，以确定管理策略和个体结局。
共确定了 47 例 MDR-TB 病例的 570 名接触者，自接触以来的总随访期为 3093 人年（PYO）。在 570 名接触者中，有 49 名（8.6%）被认为可能从索引病例感染了结核分枝杆菌，其中 11/49（22.5%）的接触者接受了针对分离敏感性的预防性治疗。接受预防性治疗的接触者中未发生 MDR-TB 病例，而未接受治疗的接触者中发生了 2 例（暴露后前 2 年每 10 万 PYO 发生率为 2878）。
在这种低流行环境中，密切接触者发生 MDR-TB 传播的风险突出了公共卫生策略中涉及预防性治疗的潜力。
