From the Department of Infection and Tropical Medicine, Birmingham Heartlands Hospital, West Midlands and Department of Sexual Health, Upton Hospital, Slough, UK
From the Department of Infection and Tropical Medicine, Birmingham Heartlands Hospital, West Midlands and Department of Sexual Health, Upton Hospital, Slough, UK.
QJM. 2015 Jan;108(1):19-25. doi: 10.1093/qjmed/hcu139. Epub 2014 Jul 1.
There have been few studies on risk factors and treatment outcomes of isoniazid (H)-resistant tuberculosis (TB), and optimal treatment regimens are debated.
: To identify risk factors for H-resistant TB, describe treatment regimens and compare these to national guidelines and describe short-term outcomes of H-resistant TB in Birmingham, UK.
Retrospective case series.
Cases of H-resistant tuberculosis in Birmingham between January 1999 and December 2010 (n = 89) were compared with drug-susceptible cases (n = 2497). Treatment regimens and outcomes at 12 months from diagnosis were evaluated by case note review.
No independent predictors for H-resistant TB were found. For 76/89 (85%) patients with full treatment details available, median treatment duration was 11 months (interquartile range 9-12 months). Only 27/72 (38%) patients with H-monoresistance were treated in line with national guidelines. A further 14/72 (19%) were treated according to other recognized guidelines. Overall treatment success was 75/89 (84%). Treatment failure occurred in 6/89 (7%) patients, all developed multi-drug resistance. Poor adherence was documented in these patients and use of a non-standard regimen in one patient was not thought to have contributed to treatment failure.
No discriminating risk factors for early detection of H-resistant TB were found. Treatment regimens in clinical practice were highly varied. H-resistance can drive MDR-TB when there is evidence or suspicion of poor adherence. A low threshold for enhanced case management with directly observed therapy is warranted in this group.
关于异烟肼（H）耐药结核病（TB）的危险因素和治疗结果的研究较少，且最佳治疗方案仍存在争议。
确定 H 耐药性结核的危险因素，描述治疗方案，并与国家指南进行比较，描述英国伯明翰 H 耐药性结核的短期结果。
回顾性病例系列。
比较 1999 年 1 月至 2010 年 12 月期间伯明翰 H 耐药性结核病（n = 89）病例与药物敏感性病例（n = 2497）。通过病历回顾评估治疗方案和诊断后 12 个月的结果。
未发现 H 耐药性结核的独立预测因素。对于 76/89（85%）例有完整治疗细节的患者，中位治疗时间为 11 个月（四分位距 9-12 个月）。仅有 27/72（38%）例 H 单耐药患者按照国家指南治疗。另有 14/72（19%）例按照其他公认的指南治疗。总体治疗成功率为 75/89（84%）。89 例患者中有 6 例（7%）治疗失败，均发展为耐多药。这些患者的依从性较差，1 例患者使用非标准方案被认为与治疗失败无关。
未发现 H 耐药性结核早期检测的鉴别危险因素。临床实践中的治疗方案差异很大。当存在依从性差的证据或怀疑时，H 耐药性可导致 MDR-TB。在该组患者中，需要对强化病例管理进行低阈值直接观察治疗。
