Emerg Infect Dis. 2022 Sep;28(9):1796-1804. doi: 10.3201/eid2809.220458.
Definitions of resistance in multidrug-resistant tuberculosis (MDR TB) and extensively drug-resistant tuberculosis (XDR TB) have been updated. Pre-XDR TB, defined as MDR TB with additional resistance to fluoroquinolones, and XDR TB, with additional resistance to bedaquiline or linezolid, are frequently associated with treatment failure and toxicity. We retrospectively determined the effects of pre-XDR/XDR TB resistance on outcomes and safety of MDR TB treatment in France. The study included 298 patients treated for MDR TB at 3 reference centers during 2006-2019. Of those, 205 (68.8%) cases were fluoroquinolone-susceptible MDR TB and 93 (31.2%) were pre-XDR/XDR TB. Compared with fluoroquinolone-susceptible MDR TB, pre-XDR/XDR TB was associated with more cavitary lung lesions and bilateral disease and required longer treatment. Overall, 202 patients (67.8%) had favorable treatment outcomes, with no significant difference between pre-XDR/XDR TB (67.7%) and fluoroquinolone-susceptible MDR TB (67.8%; p = 0.99). Pre-XDR/XDR TB was not associated with higher risk for serious adverse events.
耐多药结核病（MDR-TB）和广泛耐药结核病（XDR-TB）的耐药定义已经更新。在耐多药结核病的基础上，对氟喹诺酮类药物耐药的被定义为预广泛耐药结核病（Pre-XDR-TB），对贝达喹啉或利奈唑胺耐药的被定义为广泛耐药结核病（XDR-TB），它们通常与治疗失败和毒性有关。我们回顾性地确定了法国耐多药结核病治疗中，预广泛耐药/广泛耐药结核病耐药对结局和安全性的影响。这项研究纳入了 2006 年至 2019 年期间在 3 个参考中心接受耐多药结核病治疗的 298 名患者。其中，205 例（68.8%）为氟喹诺酮类药物敏感耐多药结核病，93 例（31.2%）为预广泛耐药/广泛耐药结核病。与氟喹诺酮类药物敏感耐多药结核病相比，预广泛耐药/广泛耐药结核病更易发生空洞性肺病变和双侧病变，需要更长的治疗时间。总体而言，202 例患者（67.8%）有良好的治疗结局，预广泛耐药/广泛耐药结核病与氟喹诺酮类药物敏感耐多药结核病之间（67.7%和 67.8%；p=0.99）无显著差异。预广泛耐药/广泛耐药结核病与严重不良事件风险增加无关。
