Kempker Russell R, Kipiani Maia, Mirtskhulava Veriko, Tukvadze Nestani, Magee Matthew J, Blumberg Henry M
Emerg Infect Dis. 2015 Jun;21(6):992-1001. doi: 10.3201/eid2106.141873.
Rates and risk factors for acquired drug resistance and association with outcomes among patients with multidrug-resistant tuberculosis (MDR TB) are not well defined. In an MDR TB cohort from the country of Georgia, drug susceptibility testing for second-line drugs (SLDs) was performed at baseline and every third month. Acquired resistance was defined as any SLD whose status changed from susceptible at baseline to resistant at follow-up. Among 141 patients, acquired resistance in Mycobacterium tuberculosis was observed in 19 (14%); prevalence was 9.1% for ofloxacin and 9.8% for capreomycin or kanamycin. Baseline cavitary disease and resistance to >6 drugs were associated with acquired resistance. Patients with M. tuberculosis that had acquired resistance were at significantly increased risk for poor treatment outcome compared with patients without these isolates (89% vs. 36%; p<0.01). Acquired resistance occurs commonly among patients with MDR TB and impedes successful treatment outcomes.
耐多药结核病（MDR TB）患者获得性耐药的发生率、危险因素及其与治疗结果的关联尚未明确界定。在格鲁吉亚的一个MDR TB队列中，在基线时以及每三个月对二线药物（SLD）进行药敏试验。获得性耐药定义为任何一种SLD的状态从基线时的敏感变为随访时的耐药。在141例患者中，19例（14%）观察到结核分枝杆菌获得性耐药；氧氟沙星的耐药率为9.1%，卷曲霉素或卡那霉素的耐药率为9.8%。基线空洞性病变和对>6种药物耐药与获得性耐药相关。与没有这些分离株的患者相比，具有获得性耐药的结核分枝杆菌患者治疗效果不佳的风险显著增加（89%对36%；p<0.01）。获得性耐药在MDR TB患者中普遍存在，并阻碍治疗取得成功结果。
