StopTB Italia Onlus, Milan, Italy, Department of Infectious, Tropical Diseases and Microbiology, Istituto di Ricovero e Cura a Carattere Scientific (IRCCS) Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy.
StopTB Italia Onlus, Milan, Italy, Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy.
Int J Tuberc Lung Dis. 2021 May 1;25(5):395-399. doi: 10.5588/ijtld.21.0036.
Treatment outcomes in multidrug-resistant TB (MDR-TB) patients are suboptimal in several low-incidence countries. The primary outcome measure was the proportion of successfully treated patients in Italy during an 18-year period. Secondary outcomes were treatment outcomes in certain drug-containing regimens and the possibility for the WHO shorter MDR-TB regimen. In the 191 patients included (median age at admission: 33 years; 67.5% male, following drug-resistance patterns were found: MDR-TB in 68.6%, pre-extensively drug-resistant TB (pre-XDR-TB) in 30.4% and XDR-TB in 1.1% patients. The most frequently prescribed drugs were fluoroquinolones in 84.6% cases, amikacin in 48.7%, linezolid in 34.6% and meropenem/clavulanic acid in 29.5%. The median duration of treatment was 18 months. Treatment success was achieved in 71.2% patients, of whom, 44% were cured and 27.2% completed treatment. Treatment success rates did not statistically differ between the MDR- (68.8%) and pre-XDR-TB (77.6%) groups ( = 0.26). Treatment success rates had large variability between North and South of Italy (81.3% vs. 53.3%). Only 22.5% of the cases would have been eligible for shorter MDR-TB regimens Our study highlights variability in treatment outcomes in MDR- and pre-XDR-TB patients. Study findings confirmed the potential utility of linezolid and, for patients with limited oral options, meropenem/clavulanic acid and amikacin.
在一些低发病率国家，耐多药结核病（MDR-TB）患者的治疗结果并不理想。主要结局指标是意大利在 18 年期间成功治疗患者的比例。次要结局指标是特定药物治疗方案的治疗结果以及世卫组织较短的 MDR-TB 方案的可能性。在纳入的 191 例患者中（入院时的中位年龄：33 岁；67.5%为男性），发现以下耐药模式：耐多药结核病（MDR-TB）占 68.6%，耐多药结核病前（pre-XDR-TB）占 30.4%，广泛耐药结核病（XDR-TB）占 1.1%。最常开的药物是氟喹诺酮类药物（84.6%）、阿米卡星（48.7%）、利奈唑胺（34.6%）和亚胺培南/克拉维酸（29.5%）。治疗中位数为 18 个月。71.2%的患者治疗成功，其中 44%治愈，27.2%完成治疗。MDR-TB（68.8%）和 pre-XDR-TB（77.6%）组的治疗成功率无统计学差异（=0.26）。意大利北部和南部之间的治疗成功率存在很大差异（81.3%对 53.3%）。只有 22.5%的病例符合较短的 MDR-TB 方案的条件。本研究强调了 MDR-TB 和 pre-XDR-TB 患者治疗结果的可变性。研究结果证实了利奈唑胺的潜在效用，对于口服选择有限的患者，亚胺培南/克拉维酸和阿米卡星也是如此。
