Mor Z, Goldblatt D, Kaidar-Shwartz H, Cedar N, Rorman E, Chemtob D
Department of Tuberculosis and AIDS, Ministry of Health, Jerusalem, Israel.
National Tuberculosis Laboratory, National Public Health Laboratory, Ministry of Health, Tel Aviv, Israel.
Int J Tuberc Lung Dis. 2014 Oct;18(10):1195-201. doi: 10.5588/ijtld.14.0192.
All culture-positive tuberculosis (TB) isolates in Israel.
To outline the magnitude of drug-resistant TB in Israel, describe treatment outcomes and identify risk factors.
Retrospective study of laboratory data of all strains of adult TB patients tested for resistance to first- and second-line anti-tuberculosis drugs between 1999 and 2010.
Of 4652 reported TB cases, 3552 (76.3%) underwent culture (annual range 73-81%); 445 (12.5%) were resistant to one or more first-line drugs, while 207 (5.8%) had multidrug-resistant TB (MDR-TB). Risk factors for MDR-TB included being male, age 30-59 years, migrants (mainly from the former Soviet Union [FSU]) who had stayed in Israel >2 years, and having pulmonary TB, human immunodeficiency virus (HIV) infection and sputum smear positivity. Of all MDR-TB patients, 71.0% achieved treatment success, while 19.8% died. Twelve Israeli citizens had extensively drug-resistant TB (5.8% of MDR-TB cases). All had emigrated from the FSU and had pulmonary TB; 1 was HIV-infected. Seven (58.4%) achieved treatment success and 5 (41.6%) died.
Drug-resistant TB in Israel is influenced by migration, especially from the FSU, where the patients were probably infected. Rapid sputum sampling performed in the early stages of the disease, patient isolation and drug susceptibility testing should be the standard of care to avoid further transmission and improve TB control.
以色列所有培养呈阳性的结核病（TB）分离株。
概述以色列耐多药结核病的规模，描述治疗结果并确定危险因素。
对1999年至2010年间接受一线和二线抗结核药物耐药性检测的所有成年结核病患者菌株的实验室数据进行回顾性研究。
在报告的4652例结核病病例中，3552例（76.3%）进行了培养（年范围为73 - 81%）；445例（12.5%）对一种或多种一线药物耐药，而207例（5.8%）患有耐多药结核病（MDR - TB）。MDR - TB的危险因素包括男性、30 - 59岁、移民（主要来自前苏联[FSU]）且在以色列居住超过2年、患有肺结核、人类免疫缺陷病毒（HIV）感染以及痰涂片阳性。在所有MDR - TB患者中，71.0%治疗成功，19.8%死亡。12名以色列公民患有广泛耐药结核病（占MDR - TB病例的5.8%）。他们均从前苏联移民而来且患有肺结核；1例感染了HIV。7例（58.4%）治疗成功，5例（41.6%）死亡。
以色列的耐多药结核病受移民影响，尤其是来自前苏联地区，患者可能在那里感染。在疾病早期进行快速痰标本采样、患者隔离和药敏试验应成为标准治疗措施，以避免进一步传播并改善结核病控制。
