埃塞俄比亚中部奥罗米亚州阿尔西地区希托萨区原发性和继发性耐多药结核病情况
Primary and secondary anti-tuberculosis drug resistance in Hitossa District of Arsi Zone, Oromia Regional State, Central Ethiopia.
作者信息
Hamusse Shallo Daba, Teshome Dejene, Hussen Mohammed Suaudi, Demissie Meaza, Lindtjørn Bernt
机构信息
Oromia Regional Health Bureau, Addis Ababa, Ethiopia.
Centre for International Health, University of Bergen, Bergen, Norway.
出版信息
BMC Public Health. 2016 Jul 18;16:593. doi: 10.1186/s12889-016-3210-y.
BACKGROUND
Multidrug-resistant tuberculosis (MDR-TB) drugs which is resistant to the major first-line anti-TB drugs, Isoniazid and Rifampicin, has become a major global challenge in tuberculosis (TB) control programme. However, its burden at community level is not well known. Thus, the aim of study was to assess the prevalence of primary and secondary resistance to any first line anti-TB drugs and MDR TB in Hitossa District of Oromia Regional State, Central Ethiopia.
METHODS
Population based cross- sectional study was conducted on individuals aged ≥15 years. Those with symptoms suggestive of TB were interviewed and two sputum specimens were collected from each and examined using Lowenstein-Jensen (LJ) culture medium. Further, the isolates were confirmed by the Ziehl-Neelsen microscopic examination method. Drug susceptibility test (DST) was also conducted on LJ medium using a simplified indirect proportion method. The resistance strains were then determined by percentage of colonies that grew on the critical concentration of Isoniazid, Streptomycin, Rifampicin and Ethambutol.
RESULTS
The overall resistance of all forms of TB to any first-line anti-TB drug was 21.7 %. Of the total new and previously treated culture positive TB cases, 15.3 and 48.8 % respectively were found to be a resistant to any of the first-line anti-TB drugs. Further, of all forms of TB, the overall resistance of MDR-TB was 4.7 %. However, of the total new TB cases, 2.4 % had primary while 14.3 % had secondary MDR-TB. Resistance to any of the first-line anti-TB drugs (adjusted odd ratio (AOR), 8.1; 95 % CI: 2.26-29.30) and MDR-TB (AOR), 7.1; 95 % CI: 2.6-43.8) was found to be linked with previous history of anti-TB treatment.
CONCLUSIONS
The study has identified a high rate of primary and secondary resistance to any of the first-line anti-TB drugs and MDR-TB in the study area. The resistance may have resulted from sub-optimal performance of directly observed treatment short-course (DOTS) programme in the detecting infectious TB cases and cure rates in the study area. Anti-TB drug resistance is linked with previous TB treatment. There is a need to strengthen DOTS and DOTS-Plus programmes and expand MDR-TB diagnostic facilities in order to timely diagnose MDR-TB cases and provide appropriate treatment to prevent the spread of MDR-TB in Ethiopia.
背景
耐多药结核病（MDR-TB）对主要的一线抗结核药物异烟肼和利福平耐药，已成为全球结核病控制规划中的一项重大挑战。然而，其在社区层面的负担尚不为人所知。因此，本研究的目的是评估埃塞俄比亚中部奥罗米亚州希托萨区对任何一线抗结核药物的原发和继发耐药情况以及耐多药结核病的患病率。
方法
对年龄≥15岁的个体进行基于人群的横断面研究。对有结核病疑似症状的患者进行访谈，并从每人采集两份痰标本，使用罗-琴（LJ）培养基进行检测。此外，通过萋-尼氏显微镜检查法对分离菌进行确认。还在LJ培养基上采用简化间接比例法进行药物敏感性试验（DST）。然后根据在异烟肼、链霉素、利福平及乙胺丁醇临界浓度下生长的菌落百分比来确定耐药菌株。
结果
所有类型结核病对任何一线抗结核药物的总体耐药率为21.7%。在所有新发病例和既往治疗过的培养阳性结核病病例中，分别有15.3%和48.8%被发现对任何一线抗结核药物耐药。此外，所有类型结核病中耐多药结核病的总体耐药率为4.7%。然而，在所有新发病例中，2.4%为原发耐多药结核病，14.3%为继发耐多药结核病。发现对任何一线抗结核药物耐药（调整比值比（AOR），8.1；95%置信区间：2.26 - 29.30）和耐多药结核病（AOR），7.1；95%置信区间：2.6 - 43.8）与既往抗结核治疗史有关。
结论
该研究发现研究区域内对任何一线抗结核药物的原发和继发耐药率以及耐多药结核病患病率都很高。这种耐药可能是由于该研究区域在发现传染性结核病病例和治愈率方面直接观察治疗短程（DOTS）规划的执行效果欠佳所致。抗结核药物耐药与既往结核病治疗有关。有必要加强DOTS和DOTS Plus规划，并扩大耐多药结核病诊断设施，以便及时诊断耐多药结核病病例并提供适当治疗，从而防止耐多药结核病在埃塞俄比亚传播。
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