Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
PLoS One. 2013 Dec 23;8(12):e83006. doi: 10.1371/journal.pone.0083006. eCollection 2013.
Development of resistance to antituberculosis drugs during treatment (i.e., acquired resistance) can lead to emergence of resistant strains and consequent poor clinical outcomes. However, it is unknown whether Mycobacterium tuberculosis complex species and lineage affects the likelihood of acquired resistance.
We analyzed data from the U.S. National Tuberculosis Surveillance System and National Tuberculosis Genotyping Service for tuberculosis cases during 2004-2011 with assigned species and lineage and both initial and final drug susceptibility test results. We determined univariate associations between species and lineage of Mycobacterium tuberculosis complex bacteria and acquired resistance to isoniazid, rifamycins, fluoroquinolones, and second-line injectables. We used Poisson regression with backward elimination to generate multivariable models for acquired resistance to isoniazid and rifamycins.
M. bovis was independently associated with acquired resistance to isoniazid (adjusted prevalence ratio = 8.46, 95% CI 2.96-24.14) adjusting for HIV status, and with acquired resistance to rifamycins (adjusted prevalence ratio = 4.53, 95% CI 1.29-15.90) adjusting for homelessness, HIV status, initial resistance to isoniazid, site of disease, and administration of therapy. East Asian lineage was associated with acquired resistance to fluoroquinolones (prevalence ratio = 6.10, 95% CI 1.56-23.83).
We found an association between mycobacterial species and lineage and acquired drug resistance using U.S. surveillance data. Prospective clinical studies are needed to determine the clinical significance of these findings, including whether rapid genotyping of isolates at the outset of treatment may benefit patient management.
治疗过程中对抗结核药物产生耐药性（即获得性耐药）可导致耐药菌株的出现，并带来不良的临床结局。然而，目前尚不清楚结核分枝杆菌复合群的物种和谱系是否会影响获得性耐药的可能性。
我们分析了 2004 年至 2011 年期间美国国家结核病监测系统和国家结核病基因分型服务的数据，这些数据涵盖了已确定物种和谱系的结核病病例，以及初始和最终药敏试验结果。我们确定了结核分枝杆菌复合群细菌的物种和谱系与异烟肼、利福平、氟喹诺酮类药物和二线注射类药物获得性耐药之间的单变量关联。我们使用泊松回归和向后消除法生成了异烟肼和利福平获得性耐药的多变量模型。
在调整了 HIV 状态后，牛分枝杆菌独立与异烟肼获得性耐药相关（调整后患病率比为 8.46，95%CI 2.96-24.14），与利福平获得性耐药相关（调整后患病率比为 4.53，95%CI 1.29-15.90），该调整考虑了无家可归、HIV 状态、初始异烟肼耐药、疾病部位和治疗管理。东亚谱系与氟喹诺酮类药物获得性耐药相关（患病率比为 6.10，95%CI 1.56-23.83）。
我们使用美国监测数据发现了分枝杆菌物种和谱系与获得性耐药之间的关联。需要前瞻性临床研究来确定这些发现的临床意义，包括在治疗开始时对分离物进行快速基因分型是否可能有益于患者管理。
