Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.
Sci Rep. 2022 Jun 27;12(1):10844. doi: 10.1038/s41598-022-14581-4.
Tuberculosis (TB) remains a leading infectious disease killer globally. Treatment outcomes are especially poor among people with extensively drug-resistant (XDR) TB, until recently defined as rifampicin-resistant (RR) TB with resistance to an aminoglycoside (amikacin) and a fluoroquinolone (ofloxacin). We used laboratory TB test results from Western Cape province, South Africa between 2012 and 2015 to identify XDR-TB and pre-XDR-TB (RR-TB with resistance to one second-line drug) spatial hotspots. We mapped the percentage and count of individuals with RR-TB that had XDR-TB and pre-XDR-TB across the province and in Cape Town, as well as amikacin-resistant and ofloxacin-resistant TB. We found the percentage of pre-XDR-TB and the count of XDR-TB/pre-XDR-TB highly heterogeneous with geographic hotspots within RR-TB high burden areas, and found hotspots in both percentage and count of amikacin-resistant and ofloxacin-resistant TB. The spatial distribution of percentage ofloxacin-resistant TB hotspots was similar to XDR-TB hotspots, suggesting that fluoroquinolone-resistace is often the first step to additional resistance. Our work shows that interventions used to reduce XDR-TB incidence may need to be targeted within spatial locations of RR-TB, and further research is required to understand underlying drivers of XDR-TB transmission in these locations.
结核病（TB）仍然是全球主要的传染病杀手。在广泛耐药（XDR）结核病患者中，治疗效果尤其不佳，直到最近才将其定义为耐利福平（RR）结核病，对氨基糖苷类（阿米卡星）和氟喹诺酮类（氧氟沙星）具有耐药性。我们使用南非西开普省 2012 年至 2015 年期间的实验室结核病检测结果，确定了 XDR-TB 和预 XDR-TB（对一种二线药物耐药的 RR-TB）的空间热点。我们绘制了全省和开普敦的 RR-TB 中具有 XDR-TB 和预 XDR-TB 的个体的百分比和数量，以及阿米卡星耐药和氧氟沙星耐药的结核病。我们发现，在 RR-TB 高负担地区内，预 XDR-TB 的百分比和 XDR-TB/预 XDR-TB 的数量存在高度异质性，并且在阿米卡星耐药和氧氟沙星耐药的结核病的百分比和数量上都存在热点。氟喹诺酮耐药结核病热点的空间分布与 XDR-TB 热点相似，这表明氟喹诺酮耐药性通常是产生其他耐药性的第一步。我们的工作表明，用于降低 XDR-TB 发病率的干预措施可能需要针对 RR-TB 的空间位置进行，还需要进一步研究这些地点中 XDR-TB 传播的潜在驱动因素。
