de la Hoz R E, Waycott S, Garcia D, Melendez R, Bia F J
Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.
Am J Trop Med Hyg. 1997 Jan;56(1):24-6. doi: 10.4269/ajtmh.1997.56.24.
Antituberculous (anti-TB) drug resistance has become a major tuberculosis control issue in the United States, where this situation has closely paralleled the current acquired immunodeficiency syndrome epidemic associated with human immunodeficiency virus type-1 (HIV-1) infections. In less developed countries, especially those like Nicaragua with an apparently low prevalence of known HIV-1 infections, less is known about the epidemiology of antituberculous drug resistance. To understand the potential extent of this problem in Nicaragua, we conducted a cross-sectional prevalence study at Nicaragua's only inpatient tuberculosis treatment facility, located in Leon, Nicaragua. A radiometric method was used during recovery, purification, and drug susceptibility testing of clinical Mycobacterium tuberculosis isolates. Resistance to at least one of the major anti-TB medications was found in 15 (40.5%) of 37 sputum isolates, of which seven (19%) were resistant to either isoniazid alone, or to isoniazid plus another agent other than rifampin. Five were resistant to at least isoniazid and rifampin (i.e., 13.5% demonstrated multidrug resistance). Two isolates were resistant to pyrazinamide alone, and one was resistant to streptomycin alone. These initial results suggest that anti-TB drug resistance is a defined problem for tuberculosis control programs in Nicaragua, a problem that is largely related to individual noncompliance, lack of extensive drug susceptibility testing facilities, and a general unavailability of expensive anti-TB medications for re-treatment. Ongoing surveillance for drug resistance, using the methodology presented here, might assist Nicaraguan public health officials in their tuberculosis control programs.
抗结核药物耐药性已成为美国结核病控制的一个主要问题，在美国，这种情况与当前由1型人类免疫缺陷病毒（HIV-1）感染所致的获得性免疫缺陷综合征流行情况密切相似。在欠发达国家，尤其是像尼加拉瓜这样已知HIV-1感染患病率明显较低的国家，对抗结核药物耐药性的流行病学了解较少。为了解尼加拉瓜这一问题的潜在严重程度，我们在尼加拉瓜莱昂市唯一的住院结核病治疗机构开展了一项横断面患病率研究。在对临床结核分枝杆菌分离株进行回收、纯化及药敏试验过程中采用了一种放射性测量方法。在37份痰液分离株中，有15份（40.5%）对至少一种主要抗结核药物耐药，其中7份（19%）仅对异烟肼耐药，或对异烟肼加除利福平之外的另一种药物耐药。5份对至少异烟肼和利福平耐药（即13.5%表现为耐多药）。2份分离株仅对吡嗪酰胺耐药，1份仅对链霉素耐药。这些初步结果表明，抗结核药物耐药性是尼加拉瓜结核病控制项目中一个明确存在的问题，该问题在很大程度上与个体不依从、缺乏广泛的药敏试验设施以及再治疗用昂贵抗结核药物普遍难以获取有关。采用本文介绍的方法持续监测耐药性，可能有助于尼加拉瓜公共卫生官员开展结核病控制项目。
