Schaberg T, Gloger G, Reichert B, Mauch H, Lode H
Pneumologie, Institut für Mikrobiologie, Immunologie und Laboratoriumsmedizin, Berlin.
Pneumologie. 1996 Jan;50(1):21-7.
Resistance of Mycobacterium tuberculosis (M. tb) strains is an increasing problem worldwide. Since no public health data are available for urban populations in Germany, we investigated resistance in our hospitalized patients (n = 1011) during the last seven years. We evaluated clinical data and results of susceptibility tests (break-point technique/proportion method) for isoniazid, streptomycin, rifampin, pyrazinamide, protionamide, and ethambutol. Since 1987 there has been a relatively constant rate of 5.9% (3.9-7.8%) for single-drug resistance (SDR) but an increasing rate of multidrug-resistant (MDR) strains (> or = 2 first-line drugs) from 1.7% in 1987 to 5.8% in 1993. 69% of patients with MDR strains showed resistance to two drugs and 31% to three or more drugs. Risk factors for SDR and MDR tuberculosis revealed previous therapy (odds ratio (OR) [CI95%] SDR: 2.2 [1.7-4.0]; MDR: 4.5 [2.3-8.8]) and foreign-born status (SDR: 2.2 [1.3-3.6]; MDR: 3.5 [1.8-6.8]) to be the most important factors associated with resistance (p < 0.006-0.0001). Both primary and acquired resistance was higher in foreign-born than in German-born patients (p < 0.005). There was a considerable increase in multidrug-resistant tuberculosis in our hospital during 1987 and 1993. Since previously treated patients and patients born in countries with a high level of primary resistance had an increased risk of drug-resistant tuberculosis, we would advise a four-drug regimen as initial therapy in those patients.
结核分枝杆菌（M. tb）菌株的耐药性在全球范围内是一个日益严重的问题。由于德国城市人口没有公共卫生数据，我们调查了过去七年中住院患者（n = 1011）的耐药情况。我们评估了异烟肼、链霉素、利福平、吡嗪酰胺、丙硫异烟胺和乙胺丁醇的临床数据和药敏试验结果（断点技术/比例法）。自1987年以来，单药耐药（SDR）率相对稳定，为5.9%（3.9 - 7.8%），但耐多药（MDR）菌株（≥2种一线药物）的比例从1987年的1.7%上升至1993年的5.8%。69%的耐多药菌株患者对两种药物耐药，31%对三种或更多药物耐药。单药耐药和耐多药结核病的危险因素显示，既往治疗史（优势比（OR）[CI95%] 单药耐药：2.2 [1.7 - 4.0]；耐多药：4.5 [2.3 - 8.8]）和外国出生身份（单药耐药：2.2 [1.3 - 3.6]；耐多药：3.5 [1.8 - 6.8]）是与耐药相关的最重要因素（p < 0.006 - 0.0001）。外国出生患者的原发耐药和获得性耐药均高于德国出生患者（p < 0.005）。1987年至1993年期间，我院耐多药结核病显著增加。由于既往接受治疗的患者以及出生在原发耐药率高的国家的患者发生耐药结核病的风险增加，我们建议对这些患者采用四联疗法作为初始治疗方案。
