确定南非耐药结核病分子聚类的风险因素。
Determining the risk-factors for molecular clustering of drug-resistant tuberculosis in South Africa.
机构信息
Centre for Tuberculosis, National Institute of Communicable Diseases, Moderfontein Road, Sandringham, Johannesburg, code 2131, South Africa.
Centre for Enteric Diseases, National Institute of Communicable Diseases, Sandringham, Johannesburg, South Africa.
出版信息
BMC Public Health. 2023 Nov 24;23(1):2329. doi: 10.1186/s12889-023-17234-x.
BACKGROUND
Drug-resistant tuberculosis (DR-TB) epidemic is driven mainly by the effect of ongoing transmission. In high-burden settings such as South Africa (SA), considerable demographic and geographic heterogeneity in DR-TB transmission exists. Thus, a better understanding of risk-factors for clustering can help to prioritise resources to specifically targeted high-risk groups as well as areas that contribute disproportionately to transmission.
METHODS
The study analyzed potential risk-factors for recent transmission in SA, using data collected from a sentinel molecular surveillance of DR-TB, by comparing demographic, clinical and epidemiologic characteristics with clustering and cluster sizes. A genotypic cluster was defined as two or more patients having identical patterns by the two genotyping methods used. Clustering was used as a proxy for recent transmission. Descriptive statistics and multinomial logistic regression were used.
RESULT
The study identified 277 clusters, with cluster size ranging between 2 and 259 cases. The majority (81.6%) of the clusters were small (2-5 cases) with few large (11-25 cases) and very large (≥ 26 cases) clusters identified mainly in Western Cape (WC), Eastern Cape (EC) and Mpumalanga (MP). In a multivariable model, patients in clusters including 11-25 and ≥ 26 individuals were more likely to be infected by Beijing family, have XDR-TB, living in Nelson Mandela Metro in EC or Umgungunglovo in Kwa-Zulu Natal (KZN) provinces, and having history of imprisonment. Individuals belonging in a small genotypic cluster were more likely to infected with Rifampicin resistant TB (RR-TB) and more likely to reside in Frances Baard in Northern Cape (NC).
CONCLUSION
Sociodemographic, clinical and bacterial risk-factors influenced rate of Mycobacterium tuberculosis (M. tuberculosis) genotypic clustering. Hence, high-risk groups and hotspot areas for clustering in EC, WC, KZN and MP should be prioritized for targeted intervention to prevent ongoing DR-TB transmission.
背景
耐药结核病（DR-TB）的流行主要是由持续传播的影响驱动的。在南非（SA）等高负担国家，DR-TB 传播存在相当大的人口统计学和地理异质性。因此，更好地了解聚类的风险因素有助于将资源优先分配给特定的高风险群体以及对传播贡献不成比例的地区。
方法
本研究通过比较两种基因分型方法的患者基因型模式，利用从 DR-TB 分子监测哨点收集的数据，分析了南非近期传播的潜在风险因素，比较了人口统计学、临床和流行病学特征与聚类和聚类大小。一个基因簇被定义为两个或更多患者具有两种基因分型方法相同的模式。聚类被用作近期传播的替代指标。采用描述性统计和多项逻辑回归进行分析。
结果
本研究确定了 277 个聚类，聚类大小范围为 2 至 259 例。大多数（81.6%）聚类较小（2-5 例），少数较大（11-25 例）和非常大（≥26 例）聚类主要在西开普省（WC）、东开普省（EC）和姆普马兰加省（MP）发现。在多变量模型中，包括 11-25 例和≥26 例患者的聚类中的患者更有可能感染北京家族，患有广泛耐药结核病（XDR-TB），居住在 EC 的纳尔逊·曼德拉大都市区或夸祖鲁-纳塔尔省（KZN）的乌姆古隆格洛沃，并有入狱史。属于小型基因聚类的个体更有可能感染利福平耐药结核病（RR-TB），并且更有可能居住在北开普省（NC）的弗朗斯堡。
结论
社会人口统计学、临床和细菌风险因素影响结核分枝杆菌（M. tuberculosis）基因型聚类的速度。因此，EC、WC、KZN 和 MP 中高风险群体和聚类热点地区应优先考虑进行针对性干预，以防止持续的 DR-TB 传播。
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