Espinal M A, Báez J, Soriano G, Garcia V, Laszlo A, Reingold A L, Sanchez S
National Research Center for Maternal and Child Health (CENISMI), Santo Domingo, Dominican Republic.
Int J Tuberc Lung Dis. 1998 Jun;2(6):490-8.
The Dominican Republic.
To assess the extent of drug-resistant tuberculosis (TB) following the guidelines of the World Health Organization (WHO)/International Union Against Tuberculosis and Lung Disease (IUATLD) new global surveillance project on drug resistance in TB.
Using a multi-step proportional weighted approach, a sample of 688 sequential cases of smear positive pulmonary TB diagnosed between April 1994 and April 1995 was studied in six of the country's eight health regions. Pre-treatment sputum samples were cultured on Loewenstein-Jensen medium and drug susceptibility tests were performed using the economic variant of the proportion method.
Of 420 cases with drug susceptibility results, resistance to one or more drugs was observed in 43.8%; resistance was found in 52.1% of 117 TB cases with a history of previous antituberculosis treatment and in 40.6% of 303 new TB cases. In five of the six health regions surveyed, > or = 41% of strains were resistant to one or more drugs. Multidrug resistance (MDR) to isoniazid and rifampicin with or without resistance to other drugs was found in 43 (10.2%) of 420 cases, including 6.6% of new TB cases. In five of the six health regions > or = 8% of strains were classified as MDR. Independent predictors of MDR-TB included being in the age group 25 to 44 years (odds ratio [OR] = 4.2, 95% confidence interval [Cl] 1.5, 11.6; P = 0.005), being aged 45 years and over (OR = 4.5, 95% CI 1.4, 14.4; P = 0.009), and having a prior history of TB (OR = 3.7, 95% CI 1.9, 7.4; P = 0.0001).
The proportion of Mycobacterium tuberculosis strains resistant to one or more anti-TB drugs in the Dominican Republic is among the highest observed world-wide. The severity of the problem urgently requires the full implementation of TB control strategies endorsed by the WHO and the IUATID, which include political commitment to a National TB Program, case detection utilizing sputum-smear microscopy, directly observed treatment, regular drug supply, and standardised recording and reporting systems. Also, the sale of TB drugs in the private market should be controlled.
多米尼加共和国。
按照世界卫生组织（WHO）/国际抗结核和肺病联盟（IUATLD）关于结核病耐药性的新全球监测项目指南，评估耐药结核病（TB）的情况。
采用多步比例加权法，在该国八个卫生区域中的六个区域，对1994年4月至1995年4月期间确诊的688例连续性涂片阳性肺结核病例进行了研究。治疗前的痰标本在罗-琴培养基上培养，并使用比例法的经济变体进行药敏试验。
在420例有药敏结果的病例中，观察到对一种或多种药物耐药的占43.8%；在117例有既往抗结核治疗史的结核病例中，耐药率为52.1%，在303例新结核病例中为40.6%。在六个接受调查的卫生区域中的五个区域，≥41%的菌株对一种或多种药物耐药。在420例病例中的43例（10.2%）发现对异烟肼和利福平有耐多药（MDR），无论是否对其他药物耐药，其中包括6.6%的新结核病例。在六个卫生区域中的五个区域，≥8%的菌株被归类为耐多药。耐多药结核病的独立预测因素包括年龄在25至44岁之间（比值比[OR]=4.2，95%置信区间[CI]1.5，11.6；P=0.005）、年龄在45岁及以上（OR=4.5，95%CI 1.4，14.4；P=0.009）以及有结核病史（OR=3.7，95%CI 1.9，7.4；P=0.0001）。
多米尼加共和国结核分枝杆菌菌株对一种或多种抗结核药物耐药的比例是全球观察到的最高比例之一。该问题的严重性迫切需要全面实施WHO和IUATID认可的结核病控制策略，包括对国家结核病项目的政治承诺、利用痰涂片显微镜检查进行病例发现、直接观察治疗、定期药物供应以及标准化的记录和报告系统。此外，应控制私营市场上抗结核药物的销售。
