Department of Virology, University of Helsinki, Helsinki, Finland.
The Fifth People's Hospital of Suzhou, Infectious Disease Hospital Affiliated to Soochow University, Suzhou, China.
Tuberculosis (Edinb). 2023 May;140:102341. doi: 10.1016/j.tube.2023.102341. Epub 2023 Apr 6.
The impacts of acquired resistance to first-line drugs other than rifampicin during turnaround time (TAT) for drug susceptibility testing (DST) on tuberculosis (TB) treatment are unclear.
We performed a prospective cohort study to test acquired resistance to isoniazid, ethambutol and pyrazinamide during TAT for DST as risk factors for prolonged time to sputum culture conversion (SCC) and treatment failure in China. Participants included had a baseline DST result for a Mycobacterium tuberculosis (Mtb) isolate collected at TB diagnosis and a follow-up DST result for a Mtb isolate collected upon baseline DST results availability. Acquired drug resistance was identified by comparing baseline and follow-up DST results.
This study included 65 patients with acquired resistance Mtb isolates and 130 patients with consistent drug susceptibility profiles. Cox proportional hazard regression analysis demonstrated acquired isoniazid resistance (aHR 0.50, 95%CI: 0.29-0.85) and acquired pyrazinamide resistance (aHR 0.54, 95%CI: 0.36-0.81) were associated with prolonged time to SCC. Moreover, acquired isoniazid resistance (aOR 7.64, 95%CI: 2.39-16.08) and acquired pyrazinamide resistance (aOR 5.71, 95%CI: 2.31-14.12) were independently associated with treatment failure.
Acquired resistance to isoniazid and/or pyrazinamide during TAT for DST was associated with prolonged time to SCC as well as treatment failure.
在药物敏感性试验（DST）的 turnaround time（TAT）期间，除利福平以外的一线药物获得性耐药对结核病（TB）治疗的影响尚不清楚。
我们进行了一项前瞻性队列研究，以测试 DST 的 TAT 期间异烟肼、乙胺丁醇和吡嗪酰胺获得性耐药是否为中国痰培养转阴（SCC）时间延长和治疗失败的危险因素。参与者包括在 TB 诊断时采集的分枝杆菌（Mtb）分离株的基线 DST 结果和在基线 DST 结果可用时采集的 Mtb 分离株的随访 DST 结果。通过比较基线和随访 DST 结果来确定获得性药物耐药性。
这项研究包括 65 例获得性耐药 Mtb 分离株和 130 例一致性药物敏感性谱患者。Cox 比例风险回归分析表明，获得性异烟肼耐药（aHR 0.50，95%CI：0.29-0.85）和获得性吡嗪酰胺耐药（aHR 0.54，95%CI：0.36-0.81）与 SCC 时间延长有关。此外，获得性异烟肼耐药（aOR 7.64，95%CI：2.39-16.08）和获得性吡嗪酰胺耐药（aOR 5.71，95%CI：2.31-14.12）与治疗失败独立相关。
在 DST 的 TAT 期间，异烟肼和/或吡嗪酰胺获得性耐药与 SCC 时间延长以及治疗失败有关。
