Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany; Respiratory Medicine and International Health, University of Lübeck, Lübeck, Germany; German Center for Infection Research Clinical Tuberculosis Unit, Borstel, Germany; Department of Medicine, Karolinska Institute, Stockholm, Sweden.
Department of Medicine, Division of Pulmonology, Centre for Lung Infection and Immunity, Lung Institute, and Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa; South African Medical Research Council, Cape Town, South Africa; Faculty of Infectious and Tropical Diseases, Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, London, UK.
Lancet. 2019 Sep 14;394(10202):953-966. doi: 10.1016/S0140-6736(19)31882-3.
Drug-resistant tuberculosis is a major public health concern in many countries. Over the past decade, the number of patients infected with Mycobacterium tuberculosis resistant to the most effective drugs against tuberculosis (ie, rifampicin and isoniazid), which is called multidrug-resistant tuberculosis, has continued to increase. Globally, 4·6% of patients with tuberculosis have multidrug-resistant tuberculosis, but in some areas, like Kazakhstan, Kyrgyzstan, Moldova, and Ukraine, this proportion exceeds 25%. Treatment for patients with multidrug-resistant tuberculosis is prolonged (ie, 9-24 months) and patients with multidrug-resistant tuberculosis have less favourable outcomes than those treated for drug-susceptible tuberculosis. Individualised multidrug-resistant tuberculosis treatment with novel (eg, bedaquiline) and repurposed (eg, linezolid, clofazimine, or meropenem) drugs and guided by genotypic and phenotypic drug susceptibility testing can improve treatment outcomes. Some clinical trials are evaluating 6-month regimens to simplify management and improve outcomes of patients with multidrug-resistant tuberculosis. Here we review optimal diagnostic and treatment strategies for patients with drug-resistant tuberculosis and their contacts.
耐多药结核病是许多国家的一个主要公共卫生关注点。在过去十年中，感染对结核病（即利福平、异烟肼）最有效的药物耐药的结核分枝杆菌（称为耐多药结核病）的患者数量持续增加。全球有 4.6%的结核病患者患有耐多药结核病，但在一些地区，如哈萨克斯坦、吉尔吉斯斯坦、摩尔多瓦和乌克兰，这一比例超过 25%。耐多药结核病患者的治疗时间延长（即 9-24 个月），且其治疗结局不如耐多药结核病患者。新型（如贝达喹啉）和再利用（如利奈唑胺、氯法齐明或美罗培南）药物的个体化耐多药结核病治疗，并结合基因型和表型药物敏感性测试指导，可以改善治疗结局。一些临床试验正在评估 6 个月方案，以简化管理并改善耐多药结核病患者的结局。在这里，我们综述了耐多药结核病患者及其接触者的最佳诊断和治疗策略。
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