Chaves F, Dronda F, Ortega A, Alonso-Sanz M, López-Cubero L, González-López A, Catalán S
Enfermedades Infecciosas-Microbiología, Servicio de Medicina, Hospital General Penitenciario, Madrid.
Med Clin (Barc). 1995 Jan 28;104(3):85-8.
To know the prevalence of resistant tuberculosis and the characteristics of the same in the penitentiary medium in the Madrid area (Spain).
From March 1, 1991 to August 31, 1993 a prospective study was carried out in patients with isolations of Mycobacterium tuberculosis resistant to some of the common antituberculous drugs within the context of tuberculosis in a penitentiary population attended in the Hospital General Penitenciario (Madrid). Demographic, clinical, analytical, and microbiological data were collected as was that on the antituberculous treatment used. The study of sensitivities was performed by the proportions method.
Tuberculosis was diagnosed in 275 patients according to strict microbiological criteria (positive Löwenstein culture). The antibiogram was performed in 218 isolations. Twenty strains resistant to some first line antituberculous drug (9%) (confidence interval [CI] p < 0.05:6-14), 9 of which were found to be multiresistant, were detected in 20 patients. Out of the patients in whom the sensitivity of the isolate was known, 173 had not previously undergone antituberculous treatment. Six of these patients were found to be resistant to isoniazide (3.5%) (CI p < 0.05:1.4-7.7) and 2 patients were resistant to rifampicin (1.2%) (CI p < 0.5:0.2-4.5). The other 45 patients had previously undergone antituberculous drugs with 8 isolates presenting resistance to isoniazide and 11 to rifampicin. Eighty-four percent of the patients with resistant tuberculosis and 90% of the sensitive cases were coinfected with HIV infection with the differences not being statistically significant. The HIV positive patients with resistant tuberculosis showed a mean CD4 positive lymphocytes of 0.76 x 10(9)/l (CI p < 0.5:0.028-0.213) and those with sensitive tuberculosis had 0.165 x 10(9)/l (CI p < 0.05:0.133-0.196) (p < 0.01).
Tuberculosis resistant to common antituberculous drugs was detected in a Spanish penitentiary population. The level of the resistance of the isolations of Mycobacterium tuberculosis should be monitored both inside and outside of the penitentiary medium in an attempt to avoid the progression of resistant tuberculosis within the Community.
了解西班牙马德里地区监狱环境中耐多药结核病的患病率及其特征。
1991年3月1日至1993年8月31日，对马德里总监狱医院收治的监狱人群中，分离出对某些常见抗结核药物耐药的结核分枝杆菌患者进行了一项前瞻性研究。收集了人口统计学、临床、分析和微生物学数据以及所使用的抗结核治疗数据。敏感性研究采用比例法进行。
根据严格的微生物学标准（罗氏培养基培养阳性），275例患者被诊断为结核病。对218株分离菌进行了药敏试验。在20例患者中检测到20株对某些一线抗结核药物耐药（9%）（置信区间[CI]p<0.05：6-14），其中9株为多重耐药。在已知分离菌敏感性的患者中，173例此前未接受过抗结核治疗。其中6例患者对异烟肼耐药（3.5%）（CI p<0.05：1.4-7.7），2例患者对利福平耐药（1.2%）（CI p<0.5：0.2-4.5）。其他45例患者此前接受过抗结核药物治疗，8株分离菌对异烟肼耐药，11株对利福平耐药。84%的耐多药结核病患者和90%的敏感病例合并感染了HIV，差异无统计学意义。耐多药结核病的HIV阳性患者CD4阳性淋巴细胞平均为0.76×10⁹/L（CI p<0.5：0.028-0.213），敏感结核病患者为0.165×10⁹/L（CI p<0.05：0.133-0.196）（p<0.01）。
在西班牙监狱人群中检测到对常见抗结核药物耐药的结核病。应在监狱内外监测结核分枝杆菌分离株的耐药水平，以避免社区内耐多药结核病的进展。
