Glynn J R, Jenkins P A, Fine P E, Pönnighaus J M, Sterne J A, Mkandwire P K, Nyasulu S, Bliss L, Warndorff D K
Communicable Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine, UK.
Lancet. 1995 Apr 8;345(8954):907-10. doi: 10.1016/s0140-6736(95)90016-0.
There is concern that drug-resistant tuberculosis is increasing and may be concentrated among HIV-positive patients. Little information is available from developing countries, where surveillance studies are often unable to distinguish resistance in previously untreated patients (initial resistance) from resistance acquired following drug therapy, and where information on the HIV status of the patients is rare. Initial resistance patterns reflect the strains being transmitted in the community. We have studied patterns of resistance in northern Malawi, where the Lepra Evaluation Project has been collecting data on drug resistance since 1986. Initial drug sensitivity results were available for 373 new cases of tuberculosis. Initial resistance to at least one drug was found in 44 of these patients (11.8%, 95% CI 8.5-15.1): 13 were resistant to streptomycin alone, 13 to isoniazid alone, and 17 to more than one drug. Only 3 patients showed initial rifampicin resistance-1 in isolation, 1 in combination with streptomycin, and 1 with triple resistance. Drug resistance was not related to age, sex, or HIV status of the patient and there was no evidence of any increase over the period studied. There was no evidence of geographic clustering of the resistant strains, or of any increased risk of resistant strains in households with previous tuberculosis cases. Acquired resistance during follow-up was found in 5 of 329 patients with documented initially fully sensitive strains. 5 patients with initial resistance seemed to show reversion to sensitivity. The absence of an increase in drug resistance, despite an increase in tuberculosis cases over the period, is encouraging for the control programme. It emphasises the need to collect information from many areas before assuming that increases in antituberculosis drug resistance are occurring worldwide.
人们担心耐多药结核病正在增加，并且可能集中在艾滋病毒呈阳性的患者中。发展中国家提供的信息很少，在这些国家，监测研究往往无法区分先前未接受治疗的患者中的耐药性（初始耐药性）与药物治疗后获得的耐药性，而且患者艾滋病毒感染状况的信息也很少见。初始耐药模式反映了社区中正在传播的菌株。我们研究了马拉维北部的耐药模式，自1986年以来，麻风病评估项目一直在那里收集耐药性数据。有373例新结核病病例的初始药敏结果。在这些患者中，有44例（11.8%，95%可信区间8.5-15.1）被发现对至少一种药物初始耐药：13例仅对链霉素耐药，13例仅对异烟肼耐药，17例对不止一种药物耐药。只有3例患者表现出初始利福平耐药——1例单独耐药，1例与链霉素联合耐药，1例三重耐药。耐药性与患者的年龄、性别或艾滋病毒感染状况无关，并且在所研究的期间内没有任何增加的证据。没有证据表明耐药菌株存在地理聚集现象，也没有证据表明在有先前结核病病例的家庭中耐药菌株的风险增加。在329例记录显示最初完全敏感菌株的患者中，有5例在随访期间出现了获得性耐药。5例初始耐药的患者似乎表现出敏感性恢复。尽管在此期间结核病病例有所增加，但耐药性没有增加，这对控制项目来说是令人鼓舞的。这强调了在假设全球抗结核药物耐药性正在增加之前，需要从许多地区收集信息。
