Long R, Manfreda J, Mendella L, Wolfe J, Parker S, Hershfield E
Department of Medicine, University of Manitoba, Winnipeg.
CMAJ. 1993 May 1;148(9):1489-95.
To estimate the magnitude of antituberculous drug resistance and identify the risk factors for its development in tuberculosis patients in Manitoba over a 10-year period. As well, to examine the clinical course of the patients whose initial or subsequent isolates of Mycobacterium tuberculosis were resistant to one or more drugs.
Comparison of drug-resistant and non-drug-resistant cases of tuberculosis.
Manitoba.
All people with tuberculosis reported to the Central Tuberculosis Registry of Manitoba between Jan. 1, 1980, and Dec. 31, 1989.
Of 1478 cases of active tuberculosis 1086 were culture positive, and drug susceptibility testing was performed in these cases. The clinical course, including outcome of treatment, of all drug-resistant cases was described.
Of 1086 culture-positive cases of tuberculosis 77 (7.1%) were drug resistant. Odds ratios suggested that the risk of drug resistance was significantly higher among the immigrants than among the other Canadians. Compared with the other Canadians the risk of drug resistance was 9.9 times greater among the immigrants in whom tuberculosis developed within the first year after arrival in Canada and 5.4 times greater among the immigrants in whom it developed 2 to 5 years after arrival in Canada. Of the 71 patients with drug-resistant disease whose type of resistance was known 62% had never taken antituberculous drugs before and 38% had. Most (91%) of the 77 cases of drug-resistant disease were resistant to first-line drugs, especially isoniazid and streptomycin. Thirty-two (42%) of the 77 cases were resistant to two or more first-line drugs. Of patients with drug-resistant disease a subgroup of 10 had disease that became resistant to several drugs over the 10-year period. The outcome of treatment in these individuals was poor, and they presented a particular public health problem.
Resistance to one or more first-line antituberculous drugs continues to complicate the treatment of tuberculosis and may facilitate the spread of the disease.
评估抗结核药物耐药性的程度，并确定曼尼托巴省结核病患者在10年期间出现耐药性的危险因素。此外，研究初始或后续结核分枝杆菌分离株对一种或多种药物耐药的患者的临床病程。
结核病耐药病例与非耐药病例的比较。
曼尼托巴省。
1980年1月1日至1989年12月31日期间向曼尼托巴省中央结核病登记处报告的所有结核病患者。
1478例活动性结核病病例中，1086例培养阳性，并对这些病例进行了药敏试验。描述了所有耐药病例的临床病程，包括治疗结果。
1086例培养阳性的结核病病例中，77例（7.1%）耐药。比值比表明，移民中耐药风险显著高于其他加拿大人。与其他加拿大人相比，抵达加拿大后第一年内患结核病的移民中耐药风险高9.9倍，抵达加拿大后2至5年内患结核病的移民中耐药风险高5.4倍。在71例已知耐药类型的耐药疾病患者中，62%以前从未服用过抗结核药物，38%服用过。77例耐药疾病病例中，大多数（91%）对一线药物耐药，尤其是异烟肼和链霉素。77例病例中有32例（42%）对两种或更多一线药物耐药。在耐药疾病患者中，有10例在10年期间疾病对多种药物产生耐药。这些患者的治疗结果很差，构成了一个特殊的公共卫生问题。
对一种或多种一线抗结核药物的耐药性继续使结核病治疗复杂化，并可能促进疾病传播。
