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在南非德班,异烟肼单耐药结核病与治疗效果不佳有关。

Isoniazid-monoresistant tuberculosis is associated with poor treatment outcomes in Durban, South Africa.

作者信息

van der Heijden Y F, Karim F, Mufamadi G, Zako L, Chinappa T, Shepherd B E, Maruri F, Moosa M-Y S, Sterling T R, Pym A S

机构信息

Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.

KwaZulu-Natal Research Institute for TB and HIV, Durban.

出版信息

Int J Tuberc Lung Dis. 2017 Jun 1;21(6):670-676. doi: 10.5588/ijtld.16.0843.

Abstract

SETTING

A large tuberculosis (TB) clinic in Durban, South Africa.

OBJECTIVE

To determine the association between isoniazid (INH) monoresistant TB and treatment outcomes.

DESIGN

We performed a retrospective longitudinal study of patients seen from 2000 to 2012 to compare episodes of INH-monoresistant TB with those of drug-susceptible TB using logistic regression with robust standard errors. INH-monoresistant TB was treated with modified regimens.

RESULTS

Among 18 058 TB patients, there were 19 979 TB episodes for which drug susceptibility testing was performed. Of these, 557 were INH-monoresistant and 16 311 were drug-susceptible. Loss to follow-up, transfer, and human immunodeficiency virus (HIV) co-infection (41% had known HIV status) were similar between groups. INH-monoresistant episodes were more likely to result in treatment failure (4.1% vs. 0.6%, P < 0.001) and death (3.2% vs. 1.8%, P = 0.01) than drug-susceptible episodes. After adjustment for age, sex, race, retreatment status, and disease site, INH-monoresistant episodes were more likely to have resulted in treatment failure (OR 6.84, 95%CI 4.29-10.89, P < 0.001) and death (OR 1.81, 95%CI 1.11-2.95, P = 0.02).

CONCLUSION

INH monoresistance was associated with worse clinical outcomes than drug-susceptible TB. Our findings support the need for rapid diagnostic tests for INH resistance and improved treatment regimens for INH-monoresistant TB.

摘要

背景

南非德班的一家大型结核病诊所。

目的

确定异烟肼(INH)单耐药结核病与治疗结果之间的关联。

设计

我们对2000年至2012年期间就诊的患者进行了一项回顾性纵向研究,使用稳健标准误的逻辑回归比较异烟肼单耐药结核病发作与药物敏感结核病发作情况。异烟肼单耐药结核病采用改良方案治疗。

结果

在18058例结核病患者中,有19979次结核病发作进行了药物敏感性检测。其中,557例为异烟肼单耐药,16311例为药物敏感。两组之间的失访、转诊和人类免疫缺陷病毒(HIV)合并感染(41%已知HIV状态)情况相似。与药物敏感发作相比,异烟肼单耐药发作更易导致治疗失败(4.1%对0.6%,P<0.001)和死亡(3.2%对1.8%,P=0.01)。在调整年龄、性别、种族、复治状态和疾病部位后,异烟肼单耐药发作更易导致治疗失败(比值比6.84,95%置信区间4.29-10.89,P<0.001)和死亡(比值比1.81,95%置信区间1.11-2.95,P=0.02)。

结论

与药物敏感结核病相比,异烟肼单耐药与更差的临床结果相关。我们的研究结果支持需要针对异烟肼耐药的快速诊断检测以及改进异烟肼单耐药结核病的治疗方案。

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