美国和原籍国的外国出生结核病病例中抗结核药物耐药性的流行情况。

Prevalence of anti-tuberculosis drug resistance in foreign-born tuberculosis cases in the U.S. and in their countries of origin.

机构信息

Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, the US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.

出版信息

PLoS One. 2012;7(11):e49355. doi: 10.1371/journal.pone.0049355. Epub 2012 Nov 7.

DOI:10.1371/journal.pone.0049355

PMID:23145161

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3492290/

Abstract

BACKGROUND

Foreign-born individuals comprise >50% of tuberculosis (TB) cases in the U.S. Since anti-TB drug resistance is more common in most other countries, when evaluating a foreign-born individual for TB, one must consider the risk of drug resistance. Naturally, clinicians query The Global Project on Anti-tuberculosis Drug Resistance Surveillance (Global DRS) which provides population-based data on the prevalence of anti-TB drug resistance in 127 countries starting in 1994. However, foreign-born persons in the U.S. are a biased sample of the population of their countries of origin, and Global DRS data may not accurately predict their risk of drug resistance. Since implementing drug resistance surveillance in 1993, the U.S. National TB Surveillance System (NTSS) has accumulated systematic data on over 130,000 foreign-born TB cases from more than 200 countries and territories. Our objective was to determine whether the prevalence of drug resistance among foreign-born TB cases correlates better with data from the Global DRS or with data on foreign-born TB cases in the NTSS.

METHODS AND FINDINGS

We compared the prevalence of resistance to isoniazid and rifampin among foreign-born TB cases in the U.S., 2007-2009, with US NTSS data from 1993 to 2006 and with Global DRS data from 1994-2007 visually with scatterplots and statistically with correlation and linear regression analyses. Among foreign-born TB cases in the U.S., 2007-2009, the prevalence of isoniazid resistance and multidrug resistance (MDR, i.e. resistance to isoniazid and rifampin), correlated much better with 1993-2006 US surveillance data (isoniazid: r = 0.95, P<.001, MDR: r = 0.75, P<.001) than with Global DRS data, 1994-2007 (isoniazid: r = 0.55, P = .001; MDR: r = 0.50, P<.001).

CONCLUSION

Since 1993, the US NTSS has accumulated sufficient data on foreign-born TB cases to estimate the risk of drug resistance among such individuals better than data from the Global DRS.

摘要

背景

在美国，超过 50%的结核病（TB）病例是由外国出生的人引起的。由于在大多数其他国家，抗结核药物耐药性更为常见，因此在评估外国出生的个体是否患有结核病时，必须考虑耐药性的风险。自然而然，临床医生会查询全球抗结核药物耐药性监测项目（Global DRS），该项目自 1994 年开始提供 127 个国家的抗结核药物耐药性流行率的基于人群的数据。然而，美国的外国出生者是其原籍国人口的有偏差的样本，Global DRS 数据可能无法准确预测他们的耐药风险。自 1993 年实施耐药监测以来，美国国家结核病监测系统（NTSS）已经积累了超过 200 个国家和地区的 130,000 多例外国出生结核病病例的系统数据。我们的目的是确定外国出生结核病病例的耐药率与 Global DRS 数据或 NTSS 中外国出生结核病病例的数据之间的相关性更好。

方法和发现

我们比较了 2007-2009 年美国的外国出生结核病病例中异烟肼和利福平耐药的流行率，以及美国 1993 年至 2006 年的 NTSS 数据和 1994 年至 2007 年的 Global DRS 数据，通过散点图进行直观比较，并通过相关性和线性回归分析进行统计学比较。在 2007-2009 年的美国外国出生结核病病例中，异烟肼耐药率和耐多药（MDR，即异烟肼和利福平耐药）与 1993-2006 年美国监测数据（异烟肼：r=0.95，P<.001，MDR：r=0.75，P<.001）的相关性要好得多，而与 1994-2007 年的 Global DRS 数据（异烟肼：r=0.55，P=.001；MDR：r=0.50，P<.001）的相关性较差。