佐治亚州亚特兰大市耐异烟肼结核病患者的痰培养转换时间和治疗结局。
Time to Sputum Culture Conversion and Treatment Outcomes Among Patients with Isoniazid-Resistant Tuberculosis in Atlanta, Georgia.
机构信息
Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine.
Rollins School of Public Health.
出版信息
Clin Infect Dis. 2017 Nov 13;65(11):1862-1871. doi: 10.1093/cid/cix686.
BACKGROUND
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.
METHODS
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.
RESULTS
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.
CONCLUSIONS
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.
背景
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。
方法
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。
结果
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。
结论
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。
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