Balay Getu, Abdella Kedir, Kebede Wakjira, Tadesse Mulualem, Bonsa Zegeye, Mekonnen Mekidim, Amare Misikir, Abebe Gemeda
Mycobacteriology Research Center, Institute of Health, Jimma University, Jimma, Ethiopia.
School of Medical Laboratory Sciences, Institute of Health, Jimma University, Jimma, Ethiopia.
J Clin Tuberc Other Mycobact Dis. 2023 Dec 25;34:100411. doi: 10.1016/j.jctube.2023.100411. eCollection 2024 Feb.
Pyrazinamide (PZA) susceptibility testing is important to develop evidence-based algorithms for case management. We aimed to assess the prevalence of PZA-resistance and its impact on treatment outcomes in previously treated tuberculosis (TB) cases in southwestern Oromia, Ethiopia.
A Phenotypic Drug Susceptibility Testing (DST) of PZA with BACTEC MGIT 960 was conducted at the Mycobacteriology Research Center of Jimma University (MRC-JU) from June to November 2021 on sixty-six complex (MTBC) isolates from previously treated TB cases. SPSS software package version 21 was used. The differences in the proportion of PZA resistance between the groups were compared using the chi squared test. Logistic regression was used to identify the association between PZA resistance and treatment outcomes.
Among 66 MTBC isolates (49 rifampicin-resistant and 17 rifampicin-sensitive) included in this study, 31.8 % were resistant to PZA. The proportion of PZA resistance was almost three times higher in previously treated TB cases with rifampicin resistance than in rifampicin-sensitive patients (38.8 % vs. 11.8 %, p = 0.039). An unfavorable treatment outcome was documented for 23 % (15/65) of the participants. Patients with PZA resistance were almost four times more likely to have an unfavorable treatment outcome than patients with PZA sensitive (aOR 4.2, 95 % CI: 1.13-15.3).
The prevalence of PZA resistance was high compared to the pooled PZA resistance estimated worldwide. The majority of TB cases with PZA resistance had an unfavorable treatment outcome. PZA susceptibility testing should be included in the multidrug-resistant TB diagnostic algorithm to improve management of these patients.
吡嗪酰胺（PZA）药敏试验对于制定基于证据的病例管理算法至关重要。我们旨在评估埃塞俄比亚奥罗米亚西南部既往治疗过的结核病（TB）病例中PZA耐药的流行情况及其对治疗结果的影响。
2021年6月至11月，在吉姆马大学分枝杆菌研究中心（MRC-JU）对66株来自既往治疗过的TB病例的结核分枝杆菌复合群（MTBC）分离株进行了PZA的表型药敏试验（DST）。使用SPSS软件包版本21。采用卡方检验比较各组间PZA耐药比例的差异。采用逻辑回归分析确定PZA耐药与治疗结果之间的关联。
本研究纳入的66株MTBC分离株（49株对利福平耐药，17株对利福平敏感）中，31.8%对PZA耐药。既往治疗过的利福平耐药TB病例中PZA耐药比例几乎是利福平敏感患者的三倍（38.8%对11.8%，p = 0.039）。23%（15/65）的参与者记录了不良治疗结果。PZA耐药患者出现不良治疗结果的可能性几乎是PZA敏感患者的四倍（调整后比值比4.2，95%置信区间：1.13 - 15.3）。
与全球估计的PZA耐药合并率相比，PZA耐药的流行率较高。大多数PZA耐药的TB病例治疗结果不佳。PZA药敏试验应纳入耐多药TB诊断算法，以改善这些患者的管理。
