Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine.
Rollins School of Public Health.
Clin Infect Dis. 2017 Nov 13;65(11):1862-1871. doi: 10.1093/cid/cix686.
Although isoniazid-resistant tuberculosis is more common than multidrug-resistant tuberculosis, it has been much less studied. We examined the impact of isoniazid resistance and treatment regimen, including use of a fluoroquinolone, on clinical outcomes.
A retrospective cohort study among patients with sputum culture-positive tuberculosis was performed. Early fluoroquinolone (FQ) use was defined as receiving ≥5 doses during the first month of treatment. The primary outcome was time to sputum culture conversion (tSCC). A multivariate proportional hazards model was used to determine the association of isoniazid resistance with tSCC.
Among 236 patients with pulmonary tuberculosis, 59 (25%) had isoniazid resistance. The median tSCC was similar for isoniazid-resistant and -susceptible cases (35 vs 29 days; P = .39), and isoniazid resistance was not associated with tSCC in multivariate analysis (adjusted hazard ratio = 0.83; 95% confidence interval [CI], .59-1.17). Early FQ use was higher in isoniazid-resistant than -susceptible cases (20% vs 10%; P = .05); however, it was not significantly associated with tSCC in univariate analysis (hazard ratio = 1.48; 95% CI, .95-2.28). Patients with isoniazid-resistant tuberculosis were treated with regimens containing rifampin, pyrazinamide, and ethambutol +/- a FQ for a median of 9.7 months. Overall, 191 (83%) patients were cured. There was no difference in initial treatment outcomes; however, all cases of acquired-drug resistance (n = 1) and recurrence (n = 3) occurred among patients with isoniazid-resistant tuberculosis.
There was no significant association with isoniazid resistance and tSCC or initial treatment outcomes. Although patients with isoniazid-resistant tuberculosis had a high cure rate, the cases of recurrence and acquired drug resistance are concerning and highlight the need for longer-term follow-up studies.
虽然异烟肼耐药结核病比耐多药结核病更为常见，但对其研究却少得多。我们研究了异烟肼耐药和治疗方案（包括使用氟喹诺酮类药物）对临床结果的影响。
对痰培养阳性肺结核患者进行回顾性队列研究。早期氟喹诺酮（FQ）使用定义为在治疗的第一个月内至少接受 5 剂。主要结局是痰培养转阴时间（tSCC）。采用多变量比例风险模型确定异烟肼耐药与 tSCC 的关系。
在 236 例肺结核患者中，有 59 例（25%）有异烟肼耐药。异烟肼耐药与敏感病例的中位 tSCC 相似（35 天与 29 天；P =.39），并且在多变量分析中，异烟肼耐药与 tSCC 无关（调整后的危险比= 0.83；95%置信区间[CI]，.59-1.17）。异烟肼耐药组比敏感组更早使用 FQ（20%比 10%；P =.05）；然而，在单变量分析中，它与 tSCC 无显著相关性（危险比= 1.48；95%CI，.95-2.28）。异烟肼耐药肺结核患者接受含利福平、吡嗪酰胺和乙胺丁醇 +/-FQ 的方案治疗，中位数为 9.7 个月。总的来说，191 例（83%）患者治愈。初始治疗结果无差异；然而，所有获得性耐药（n = 1）和复发（n = 3）病例均发生在异烟肼耐药肺结核患者中。
异烟肼耐药与 tSCC 或初始治疗结果之间没有显著关联。虽然异烟肼耐药肺结核患者的治愈率较高，但复发和获得性耐药的病例令人担忧，这突出表明需要进行更长期的随访研究。
