Department of Epidemiology and Clinical Research, the Research Institute of Tuberculosis, 3-1-24, Matsuyama Kiyose, Tokyo, Japan.
BMC Infect Dis. 2018 Aug 31;18(1):445. doi: 10.1186/s12879-018-3353-9.
Multidrug resistant-tuberculosis (MDR-TB) is a major global health concern. Its treatment requires toxic medications, is longer and costlier than drug-susceptible TB, and often results in productivity losses and poor outcomes. In Japan, a TB middle-burden country, reports on treatment outcome of MDR-TB patients have only been institution-based. We thus sought to shed some light on the nationwide treatment status and outcome of MDR-TB patients in Japan.
Characteristics and treatment status and outcome of MDR-TB patients notified between 2011 and 2013 were evaluated using the data from the Japan TB Surveillance (JTBS) system. Since the treatment outcome from the surveillance data was not directly linked to any clinical records or drug susceptible test results, we also analyzed the treatment duration of MDR-TB cases in an attempt to validate our results.
Between 2011 and 2013, a total of 172 MDR-TB patients had been notified to the JTBS as MDR-TB. 68.6% (118/172) were males and 70.9% (122/172) were Japan-born - however, over the study period, the proportions of foreign-born, of those in the age group 15-64 years old and of new cases have increased. The overall treatment completion rate was 57.0%, however, when restricted to patients aged 64 years old and below, the rate improved to 71.6%. Treatment duration of 29.2% of those patients who had been recorded as "treatment completed" in fact fell short of the 540 days, the minimum duration as recommended by the Japanese guideline.
Increasing proportion of new cases, and of younger age groups among the MDR-TB patients indicate new transmissions. Better strategies for early detection and containment of MDR-TB are urgently needed. The overall treatment completion rate was 57.0% over the three-year study period. However, when restricting the result to those aged 64 years old and below, the rate improved to 71.6%, which was comparable to similarly industrialized countries. Due to the limitations of the JTBS data, a comprehensive survey of all MDR-TB patients may be necessary to provide more concrete evidence for decision-making.
耐多药结核病（MDR-TB）是一个重大的全球卫生关注问题。它的治疗需要使用有毒药物，比敏感结核病的治疗时间更长、费用更高，而且往往导致生产力损失和不良结局。在日本这个结核病中等负担国家，有关 MDR-TB 患者治疗结果的报告仅基于机构。因此，我们试图了解日本全国范围内 MDR-TB 患者的治疗状况和结局。
使用日本结核病监测（JTBS）系统的数据，评估了 2011 年至 2013 年间报告的 MDR-TB 患者的特征、治疗状况和结局。由于监测数据中的治疗结果并未直接与任何临床记录或药敏试验结果相关联，我们还分析了 MDR-TB 病例的治疗持续时间，试图验证我们的结果。
2011 年至 2013 年间，共有 172 例 MDR-TB 患者通过 JTBS 被报告为 MDR-TB。68.6%（118/172）为男性，70.9%（122/172）为日本出生-然而，在研究期间，外国出生者、15-64 岁年龄组和新发病例的比例有所增加。总体治疗完成率为 57.0%，但将年龄限制在 64 岁以下时，该比率提高至 71.6%。在被记录为“治疗完成”的患者中，有 29.2%的患者实际上治疗时间短于日本指南推荐的 540 天最短治疗时间。
MDR-TB 患者中新发病例和年轻年龄组的比例增加表明存在新的传播。迫切需要更好的早期发现和控制耐多药结核病的策略。在三年的研究期间，总体治疗完成率为 57.0%。然而，将结果限制在 64 岁以下时，该比率提高至 71.6%，与类似工业化国家相当。由于 JTBS 数据的限制，可能需要对所有 MDR-TB 患者进行全面调查，以提供更具体的决策证据。
