Chest Hospital, Department of Health, Executive Yuan, Tainan, Taiwan.
J Antimicrob Chemother. 2013 Aug;68(8):1910-6. doi: 10.1093/jac/dkt103. Epub 2013 Apr 10.
To investigate the impact of the directly observed therapy, short course (DOTS) and DOTS-Plus strategies on changes in resistance profiles among Mycobacterium tuberculosis (MTB).
We performed a retrospective analysis of resistance profiles among isolates of MTB obtained from 2160 consecutive patients with culture-confirmed pulmonary tuberculosis (TB) between 2005 and 2011 at a referral centre in southern Taiwan.
Of the 2160 patients, 70 (3.2%) had primary multidrug-resistant (MDR)-TB, 178 (8.2%) had acquired MDR-TB, 10 (0.5%) had primary extensively drug-resistant (XDR)-TB, 23 (1.1%) had acquired XDR-TB and 5 (0.2%) had totally drug-resistant (TDR)-TB. Trend analysis revealed that the rates of acquired MDR-TB were significantly lower after implementation of the DOTS and DOTS-Plus programmes (P < 0.01). There was a significant negative correlation between the coverage rates of the DOTS and DOTS-Plus programmes and the rates of acquired MDR-TB (r = -0.84, P = 0.02 and r = -0.92, P = 0.03, respectively). The rates of resistance to rifampicin, isoniazid, ofloxacin, moxifloxacin, levofloxacin and para-aminosalicylic acid also decreased significantly during the study period. However, the rates of primary MDR-TB remained stable (P = 0.11). Multivariate logistic regression analysis showed that age ranging from 45 to 64 years, positive acid-fast stain results at the initiation of treatment and treatment without DOTS were independent risk factors associated with acquired MDR-TB. In addition, previous treatment for TB (100% versus 19% for TDR-TB and non-TDR-TB, P < 0.01) and treatment without DOTS (80% versus 44% for TDR-TB and non-TDR-TB, P = 0.18) were risk factors for TDR-TB.
DOTS and DOTS-Plus are both effective at preventing the acquisition of MDR-TB in Taiwan.
调查直接观察治疗短程方案（DOTS）和 DOTS-Plus 策略对结核分枝杆菌（MTB）耐药谱变化的影响。
我们对 2005 年至 2011 年间在台湾南部一家转诊中心经培养证实的 2160 例肺结核（TB）连续患者的 MTB 分离株耐药谱进行了回顾性分析。
2160 例患者中，70 例（3.2%）为原发性耐多药（MDR）-TB，178 例（8.2%）为获得性 MDR-TB，10 例（0.5%）为原发性广泛耐药（XDR）-TB，23 例（1.1%）为获得性 XDR-TB，5 例（0.2%）为完全耐药（TDR）-TB。趋势分析显示，实施 DOTS 和 DOTS-Plus 方案后，获得性 MDR-TB 的发生率显著降低（P＜0.01）。DOTS 和 DOTS-Plus 方案的覆盖率与获得性 MDR-TB 的发生率呈显著负相关（r=-0.84，P=0.02 和 r=-0.92，P=0.03）。研究期间，利福平、异烟肼、氧氟沙星、莫西沙星、左氧氟沙星和对氨基水杨酸的耐药率也显著下降。然而，原发性 MDR-TB 的发生率保持稳定（P=0.11）。多变量 logistic 回归分析显示，年龄在 45 至 64 岁之间、治疗开始时抗酸染色阳性结果和无 DOTS 治疗是与获得性 MDR-TB 相关的独立危险因素。此外，既往 TB 治疗（100%比 TDR-TB 和非 TDR-TB 的 19%，P＜0.01）和无 DOTS 治疗（80%比 TDR-TB 和非 TDR-TB 的 44%，P=0.18）是 TDR-TB 的危险因素。
DOTS 和 DOTS-Plus 均可有效预防台湾获得性 MDR-TB。
