分子检测异烟肼单耐药可改善结核病治疗：法国的一项回顾性队列研究。
Molecular detection of isoniazid monoresistance improves tuberculosis treatment: A retrospective cohort in France.
机构信息
Centre d'Immunologie et des Maladies Infectieuses, Sorbonne-Université, INSERM, (U1135 - E2), 4 rue de la Chine, Paris 75020, France.
Centre d'Immunologie et des Maladies Infectieuses, Sorbonne-Université, INSERM, (U1135 - E2), 4 rue de la Chine, Paris 75020, France; Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Bactériologie-Hygiène, AP-HP. Sorbonne Université, Site Pitié Salpêtrière, Paris, France.
出版信息
J Infect. 2022 Jul;85(1):24-30. doi: 10.1016/j.jinf.2022.05.017. Epub 2022 May 20.
OBJECTIVES
Isoniazid-monoresistant tuberculosis (HR-TB) requires early diagnosis and adapted treatment to achieve optimal outcomes. The primary aim of the study was to assess the impact of the implementation of rapid diagnostic tests on HR-TB treatment in France.
METHODS
We designed a retrospective multicentre study including consecutive HR-TB patients diagnosed in 2016 and 2017. Implementation of a molecular assay detecting isoniazid resistance directly on a clinical sample was recorded. The association between early implementation of such assays and adequate treatment was assessed by a multivariable Cox proportional hazards model.
RESULTS
Overall, 99 HR-TB patients were included from 20 University Hospitals. Among all smear-positive HR-TB patients, only 26% beneficiated from early molecular HR detection. This detection was independently associated with shorter time to adequate treatment (HR = 2.0 [1.1-3.8], p = 0.03).
CONCLUSION
In our study, molecular detection of HR on an initial sample was independently associated with earlier treatment adaptation.
目的
异烟肼单耐药结核病（HR-TB）需要早期诊断和适应性治疗，以实现最佳疗效。本研究的主要目的是评估快速诊断检测在法国 HR-TB 治疗中的应用效果。
方法
我们设计了一项回顾性多中心研究，纳入了 2016 年和 2017 年连续诊断的 HR-TB 患者。记录了直接在临床样本上检测异烟肼耐药的分子检测方法的应用情况。通过多变量 Cox 比例风险模型评估早期应用此类检测与适当治疗之间的关联。
结果
共纳入 20 家大学医院的 99 例 HR-TB 患者。在所有涂阳 HR-TB 患者中，只有 26%的患者受益于早期分子 HR 检测。这种检测与更短的适当治疗时间独立相关（HR=2.0[1.1-3.8]，p=0.03）。
结论
在我们的研究中，初始样本中 HR 的分子检测与更早的治疗适应性独立相关。
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