Angarano G, Carbonara S, Costa D, Gori A
Institute of Infectious Disease, University of Bari, Italy.
Int J Tuberc Lung Dis. 1998 Apr;2(4):303-11.
To describe the prevalence and epidemiological-clinical characteristics of tuberculosis (TB) resistance to first-line drugs in Italian human immunodeficiency virus (HIV)-infected subjects.
Prospective, observational multicenter (25 Centers of Infectious Diseases) study. Mycobacterium tuberculosis strains from 167 HIV co-infected subjects with TB (149 new cases, 18 relapses) were tested at a central laboratory for susceptibility to rifampin (R), isoniazid (H), pyrazinamide (Z), ethambutol (E) and streptomycin (S) and for DNA fingerprint type. Drug susceptibility results were related to patients' epidemiological, clinical and laboratory features.
Drug resistance patterns among new TB cases were as follows: R = 1%, Z = 6%, S = 8%, H + S = 3%, S + Z = 4%. TB resistant to at least R + H (MDR-TB) was detected in 36% of new cases due to an MDR-TB outbreak which was the largest thus far in Europe, involving 7/25 participating institutions, and was demonstrated by conventional and molecular epidemiology evidence. With multivariate analysis, MDR-TB was associated with hospital exposure to MDR-TB (OR = 39.3, P < 0.001) and previous use of anti-TB drugs (OR = 9.8, P = 0.008).
As drug-resistant tuberculosis in Italy is thus far relatively scarce, detection of a large MDR-TB epidemic among HIV-infected subjects was alarming. Aggressive control measures are urgently needed to prevent the spread of MDR-TB throughout the country and among the general population.
描述意大利人类免疫缺陷病毒（HIV）感染患者中结核病（TB）对一线药物耐药的患病率及流行病学-临床特征。
前瞻性、观察性多中心（25个传染病中心）研究。在一个中央实验室对167例合并感染HIV和TB的患者（149例新发病例，18例复发病例）的结核分枝杆菌菌株进行利福平（R）、异烟肼（H）、吡嗪酰胺（Z）、乙胺丁醇（E）和链霉素（S）的药敏试验及DNA指纹分型。药敏结果与患者的流行病学、临床和实验室特征相关。
新发病例中的耐药模式如下：R = 1%，Z = 6%，S = 8%，H + S = 3%，S + Z = 4%。在36%的新发病例中检测到至少对R + H耐药的结核病（耐多药结核病，MDR-TB），这是由于一次耐多药结核病暴发，这是欧洲迄今为止最大的一次，涉及25个参与机构中的7个，并得到了传统和分子流行病学证据的证实。多因素分析显示，耐多药结核病与医院接触耐多药结核病（比值比[OR] = 39.3，P < 0.001）及既往使用抗结核药物（OR = 9.8，P = 0.008）有关。
由于意大利的耐药结核病迄今为止相对较少，在HIV感染患者中检测到大规模的耐多药结核病流行令人担忧。迫切需要采取积极的控制措施，以防止耐多药结核病在全国及普通人群中传播。
