Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
Lancet. 2012 Oct 20;380(9851):1406-17. doi: 10.1016/S0140-6736(12)60734-X. Epub 2012 Aug 30.
The prevalence of extensively drug-resistant (XDR) tuberculosis is increasing due to the expanded use of second-line drugs in people with multidrug-resistant (MDR) disease. We prospectively assessed resistance to second-line antituberculosis drugs in eight countries.
From Jan 1, 2005, to Dec 31, 2008, we enrolled consecutive adults with locally confirmed pulmonary MDR tuberculosis at the start of second-line treatment in Estonia, Latvia, Peru, Philippines, Russia, South Africa, South Korea, and Thailand. Drug-susceptibility testing for study purposes was done centrally at the Centers for Disease Control and Prevention for 11 first-line and second-line drugs. We compared the results with clinical and epidemiological data to identify risk factors for resistance to second-line drugs and XDR tuberculosis.
Among 1278 patients, 43·7% showed resistance to at least one second-line drug, 20·0% to at least one second-line injectable drug, and 12·9% to at least one fluoroquinolone. 6·7% of patients had XDR tuberculosis (range across study sites 0·8-15·2%). Previous treatment with second-line drugs was consistently the strongest risk factor for resistance to these drugs, which increased the risk of XDR tuberculosis by more than four times. Fluoroquinolone resistance and XDR tuberculosis were more frequent in women than in men. Unemployment, alcohol abuse, and smoking were associated with resistance to second-line injectable drugs across countries. Other risk factors differed between drugs and countries.
Previous treatment with second-line drugs is a strong, consistent risk factor for resistance to these drugs, including XDR tuberculosis. Representative drug-susceptibility results could guide in-country policies for laboratory capacity and diagnostic strategies.
US Agency for International Development, Centers for Disease Control and Prevention, National Institutes of Health/National Institute of Allergy and Infectious Diseases, and Korean Ministry of Health and Welfare.
由于二线药物在耐多药（MDR）疾病患者中的广泛应用，广泛耐药（XDR）结核病的患病率不断增加。我们前瞻性评估了 8 个国家二线抗结核药物的耐药情况。
从 2005 年 1 月 1 日至 2008 年 12 月 31 日，我们连续招募了在爱沙尼亚、拉脱维亚、秘鲁、菲律宾、俄罗斯、南非、韩国和泰国开始二线治疗时确诊为局部肺部 MDR 结核病的成年人。为研究目的，对 11 种一线和二线药物进行了药物敏感性测试，该测试由疾病控制和预防中心集中进行。我们将结果与临床和流行病学数据进行比较，以确定对二线药物和 XDR 结核病耐药的危险因素。
在 1278 名患者中，43.7%至少对一种二线药物耐药，20.0%至少对一种二线注射药物耐药，12.9%至少对一种氟喹诺酮类药物耐药。6.7%的患者患有 XDR 结核病（研究地点范围为 0.8-15.2%）。先前使用二线药物始终是对这些药物产生耐药性的最强危险因素，这使 XDR 结核病的风险增加了四倍以上。女性比男性更易出现氟喹诺酮耐药和 XDR 结核病。在各国，失业、酗酒和吸烟与二线注射药物耐药相关。其他危险因素在药物和国家之间存在差异。
先前使用二线药物是对这些药物产生耐药性的一个强烈而一致的危险因素，包括 XDR 结核病。有代表性的药敏结果可以指导国家实验室能力和诊断策略的制定。
美国国际开发署、疾病控制和预防中心、美国国立卫生研究院/国家过敏和传染病研究所以及韩国保健福利部。
