印度孟买儿童耐多药结核病的流行率不断上升及其结局。
Increasing Prevalence of Pediatric Drug-resistant Tuberculosis in Mumbai, India, and Its Outcome.
机构信息
From the Seth GS Medical College and KEM Hospital.
B.J.Wadia Hospital, Mumbai, Maharashtra, India.
出版信息
Pediatr Infect Dis J. 2018 Dec;37(12):1261-1263. doi: 10.1097/INF.0000000000002040.
BACKGROUND
The prevalence and type of Drug resistant tuberculosis (DR-TB) was evaluated pre- and post-2013, and outcome was studied.
METHODS
Descriptive retrospective study. Children were defined as having DR-TB on the basis of GeneXpert or line probe assay and/or drug susceptibility testing (DST) of M. tuberculosis grown on culture or from contact's DST.
RESULTS
The prevalence of DR-TB was 110 of 1145 cases (9.6%), which showed an increase, compared with 5.6% pre-2010 and 7% in 2010-2013 (P = 0.014408). Twenty-two children (20%) had pulmonary-TB and 88 (80%) had extra-pulmonary-TB with disseminated-TB being the most common presentation in 31 children (28.18%). Ninety-six children (87.3%) were bacteriologically confirmed TB cases, and 14 (12.7%) were clinically diagnosed-TB and treated as per contact DST. Eight cases (7.2%) were monoresistant, 7 (6.3%) polyresistant, MDR-TB seen in 28 patients (25.45%), 32 (29.09%) had pre-XDR-TB, 9 (8.18%) had XDR-TB and 12 (10.9%) were rifampicin resistant. Ethionamide resistance increased from 26.1% pre-2013 to 60.8% post-2013 (P = 0.014408) and ofloxacin resistance rose from 30.4% pre-2010, to 47.6% in 2010-2013 and 56.9% post-2013 (P = 0.080863). Moxifloxacin resistance showed an acute rise from 8.7% pre-2010, to 46% in 2010-2013 and 57% post-2013 (P = 0.000275). Thirty-three patients (30%) had completed their treatment, 21 (19.09%) were lost to follow-up and 56 (50.09%) patients are still on treatment.
CONCLUSIONS
DR-TB is increasing in Mumbai, India. Based on the DST results, individualised therapy would be recommended.
背景
评估了 2013 年前后耐多药结核病（DR-TB）的流行率和类型，并研究了其结局。
方法
描述性回顾性研究。根据 GeneXpert 或线探针分析以及/或培养物中结核分枝杆菌的药敏试验（DST）或接触者 DST 对儿童进行耐多药结核病的定义。
结果
1145 例患者中耐多药结核病的患病率为 110 例（9.6%），与 2010 年前的 5.6%和 2010-2013 年的 7%相比有所增加（P = 0.014408）。22 例（20%）患儿患有肺结核，88 例（80%）患有肺外结核病，播散性结核病是 31 例患儿（28.18%）中最常见的表现。96 例（87.3%）患儿为菌阳结核病，14 例（12.7%）为临床诊断结核病，按接触者 DST 进行治疗。8 例（7.2%）为单耐药，7 例（6.3%）为多耐药，28 例（25.45%）患儿为耐多药结核病，32 例（29.09%）为耐多药结核病，9 例（8.18%）为广泛耐药结核病，12 例（10.9%）为利福平耐药。乙胺丁醇耐药率从 2013 年前的 26.1%增加到 2013 年后的 60.8%（P = 0.014408），氧氟沙星耐药率从 2010 年前的 30.4%上升到 2010-2013 年的 47.6%，再到 2013 年后的 56.9%（P = 0.080863）。莫西沙星耐药率从 2010 年前的 8.7%急剧上升至 2010-2013 年的 46%，再至 2013 年后的 57%（P = 0.000275）。33 例（30%）患者完成治疗，21 例（19.09%）失访，56 例（50.09%）患者仍在治疗中。
结论
耐多药结核病在印度孟买呈上升趋势。根据药敏试验结果，建议进行个体化治疗。
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