来自埃塞俄比亚的耐多药结核病疑似患者中结核分枝杆菌菌株的耐药模式及相关危险因素。

Drug-resistance patterns of Mycobacterium tuberculosis strains and associated risk factors among multi drug-resistant tuberculosis suspected patients from Ethiopia.

机构信息

Addis Ababa University, Department of Microbial, Cellular and Molecular Biology, Addis Ababa, Ethiopia.

Ethiopian Public Health Institute, Addis Ababa, Ethiopia.

出版信息

PLoS One. 2018 Jun 4;13(6):e0197737. doi: 10.1371/journal.pone.0197737. eCollection 2018.

DOI:10.1371/journal.pone.0197737

PMID:29864118

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5986145/

Abstract

BACKGROUND

Multidrug drug-resistant tuberculosis (MDR-TB) is a major health problem and seriously threatens TB control and prevention efforts globally. Ethiopia is among the 30th highest TB burden countries for MDR-TB with 14% prevalence among previously treated cases. The focus of this study was on determining drug resistance patterns of Mycobacterium tuberculosis among MDR-TB suspected cases and associated risk factors.

METHODS

A cross-sectional study was conducted in Addis Ababa from June 2015 to December 2016. Sputum samples and socio-demographic data were collected from 358 MDR-TB suspected cases. Samples were analyzed using Ziehl-Neelsen technique, GeneXpert MTB/RIF assay, and culture using Lowenstein-Jensen and Mycobacterial growth indicator tube. Data were analyzed using SPSS version 23.

RESULTS

A total of 226 the study participants were culture positive for Mycobacterium tuberculosis, among them, 133 (58.8%) participants were males. Moreover, 162 (71.7%) had been previously treated for tuberculosis, while 128 (56.6%) were TB/HIV co-infected. A majority [122 (54%)] of the isolates were resistant to any first-line anti-TB drugs. Among the resistant isolates, 110 (48.7%) were determined to be resistant to isoniazid, 94 (41.6%) to streptomycin, 89 (39.4%) to rifampicin, 72 (31.9%) to ethambutol, and 70 (30.9%) to pyrazinamide. The prevalence of MDR-TB was 89 (39.4%), of which 52/89 (58.4%) isolates were resistance to all five first-line drugs. Risk factors such as TB/HIV co-infection (AOR = 5.59, p = 0.00), cigarette smoking (AOR = 3.52, p = 0.045), alcohol drinking (AOR = 5.14, p = 0.001) hospital admission (AOR = 3.49, p = 0.005) and visiting (AOR = 3.34, p = 0.044) were significantly associated with MDR-TB.

CONCLUSIONS

The prevalence of MDR-TB in the study population was of a significantly high level among previously treated patients and age group of 25-34. TB/HIV coinfection, smoking of cigarette, alcohol drinking, hospital admission and health facility visiting were identified as risk factors for developing MDR-TB. Therefore, effective strategies should be designed considering the identified risk factors for control of MDR-TB.

摘要

背景

耐多药结核病（MDR-TB）是一个主要的健康问题，严重威胁着全球的结核病控制和预防工作。埃塞俄比亚是耐多药结核病负担最高的 30 个国家之一，既往治疗病例中耐多药结核病的患病率为 14%。本研究的重点是确定耐多药结核病疑似病例中的结核分枝杆菌耐药模式及其相关危险因素。

方法

2015 年 6 月至 2016 年 12 月在亚的斯亚贝巴进行了一项横断面研究。从 358 例耐多药结核病疑似病例中收集了痰标本和社会人口统计学数据。使用 Ziehl-Neelsen 技术、GeneXpert MTB/RIF 检测、以及 Lowenstein-Jensen 和分枝杆菌生长指示管进行培养，对样本进行分析。使用 SPSS 版本 23 对数据进行分析。

结果

共有 226 名研究参与者的结核分枝杆菌培养阳性，其中 133 名（58.8%）参与者为男性。此外，162 名（71.7%）曾接受过结核病治疗，128 名（56.6%）为结核/艾滋病毒合并感染。大多数[122 名（54%）]分离株对任何一线抗结核药物均具有耐药性。在耐药分离株中，110 株（48.7%）对异烟肼耐药，94 株（41.6%）对链霉素耐药，89 株（39.4%）对利福平耐药，72 株（31.9%）对乙胺丁醇耐药，70 株（30.9%）对吡嗪酰胺耐药。耐多药结核病的患病率为 89%（394/444），其中 52/89（58.4%）分离株对所有五种一线药物均具有耐药性。结核/艾滋病毒合并感染（AOR=5.59，p=0.00）、吸烟（AOR=3.52，p=0.045）、饮酒（AOR=5.14，p=0.001）、住院（AOR=3.49，p=0.005）和就诊（AOR=3.34，p=0.044）等危险因素与耐多药结核病显著相关。