Ignatyeva Olga, Balabanova Yanina, Nikolayevskyy Vladyslav, Koshkarova Ekaterina, Radiulyte Birute, Davidaviciene Edita, Riekstina Vija, Jaama Kadri, Danilovits Manfred, Popa Cristina M, Drobniewski Francis A
Samara Oblast Clinical Tuberculosis Dispensary, 154, Novo-Sadovaya Street, Samara 443068, Russia.
Blizard Institute, Queen Mary University of London, 2 Newark Street, London E1 2AT, UK; Department of Infectious Diseases, Imperial College, Commonwealth Building, Hammersmith Campus, DuCane Road, London W12 ONN, UK; Department for Infectious Disease Epidemiology, Robert Koch Institute, Nordufer 20, D-13353 Berlin-Wedding, Germany.
Tuberculosis (Edinb). 2015 Sep;95(5):581-8. doi: 10.1016/j.tube.2015.05.018. Epub 2015 Jun 24.
The rates of multi- and extensively drug-resistant tuberculosis (X/MDRTB) in the Baltic countries are the highest within the European Union hampering recent achievements of national TB control programmes. We included all consecutive culture-confirmed X/MDRTB patients registered for treatment in 2009 in Latvia, Lithuania and Estonia into this multicenter case-control study. Cases were compared with randomly selected controls with non-MDRTB registered for treatment in the same year across these sites. Of 495 MDRTB patients, 243 (49.7%) showed resistance to at least one second-line drug, 206 (42.1%) had pre-XDRTB (i.e. MDRTB with additional resistance to a second-line injectable or fluoroquinolones) and 64 (13.1%) had XDRTB. Younger age, male gender and known contact with an MDRTB case were associated with increased risk of primary infection with X/MDRTB strains. Previous treatment and alcohol abuse were strong predictors for MDRTB acquisition; defaults and failures in the past triggered XDRTB development. All patients received appropriate therapy; less than half of the patients were fully adherent. An erroneous treatment strategy is unlikely to drive resistance development. Increasing patients' compliance, addressing issues of social support, rapid detection of drug resistance and improving infection control is crucial for prevention of further spread of X/MDRTB and achieving higher cure rates.
波罗的海国家的多重耐药和广泛耐药结核病（X/MDRTB）发病率在欧盟范围内是最高的，这阻碍了各国结核病控制规划近期所取得的成果。我们将2009年在拉脱维亚、立陶宛和爱沙尼亚登记接受治疗的所有连续的经培养确诊的X/MDRTB患者纳入了这项多中心病例对照研究。将病例与同年在这些地点随机选取的非MDRTB登记治疗对照进行比较。在495例MDRTB患者中，243例（49.7%）对至少一种二线药物耐药，206例（42.1%）有广泛耐药结核病前期（即对一种二线注射剂或氟喹诺酮类药物有额外耐药的MDRTB），64例（13.1%）有广泛耐药结核病。年龄较小、男性以及已知与MDRTB病例有接触与感染X/MDRTB菌株的原发性感染风险增加相关。既往治疗和酗酒是获得MDRTB的有力预测因素；过去的治疗中断和治疗失败引发了广泛耐药结核病的发生。所有患者均接受了适当治疗；不到一半的患者完全依从。错误的治疗策略不太可能导致耐药性的产生。提高患者的依从性、解决社会支持问题、快速检测耐药性以及改善感染控制对于预防X/MDRTB的进一步传播和实现更高的治愈率至关重要。
