Burman W J, Stone B L, Rietmeijer C A, Maslow J, Cohn D L, Reves R R
Disease Control Service and the Mycobacteriology Laboratory, Denver Public Health, Colorado 80204, USA.
AIDS. 1998 Jul 30;12(11):1309-15. doi: 10.1097/00002030-199811000-00012.
To describe the long-term outcomes of treatment of AIDS-related Mycobacterium avium complex (MAC) bacteremia using a standard clarithromycin-based regimen.
Retrospective study of patients with MAC bacteremia diagnosed between April 1992 and April 1995.
An urban AIDS clinic
One hundred seventy-six consecutive patients with MAC bacteremia.
Clarithromycin 500 mg twice daily, ethambutol 800 or 1200 mg daily, and clofazimine 100 mg daily.
Late treatment failure (defined as a positive blood culture more than 90 days after starting treatment), clarithromycin susceptibility of initial and treatment-failure isolates, DNA fingerprinting of isolates from treatment failures.
Two out of 176 (1.1%) baseline isolates were resistant to clarithromycin. One hundred and fifty-one patients were treated for MAC bacteremia, 144 (95%) with the standard regimen. Of the 117 patients who survived > 90 days after starting therapy, 25 (21%) met the criteria for late treatment failure. Of the 22 treatment-failure isolates available for susceptibility testing, 19 (86%) were resistant to clarithromycin. Therefore, 13% of patients treated using the standard regimen (19 out of 144) had treatment failure associated with the emergence of clarithromycin resistance. Using logistic regression, non-compliance was associated with treatment failure (P = 0.02). Fourteen out of the 17 (82%) evaluable paired isolates had identical DNA fingerprint patterns, whereas three pairs showed that a different strain of MAC was present at the time of treatment failure.
Initial resistance to clarithromycin was rare during this period. However, late treatment failure associated with the emergence of clarithromycin resistance was relatively common during long-term follow-up. Most late treatment failures represented emergence of clarithromycin resistance in the initial strain.
描述采用基于克拉霉素的标准方案治疗艾滋病相关鸟分枝杆菌复合体（MAC）菌血症的长期疗效。
对1992年4月至1995年4月期间诊断为MAC菌血症的患者进行回顾性研究。
一家城市艾滋病诊所
176例连续的MAC菌血症患者。
克拉霉素500毫克，每日两次；乙胺丁醇800或1200毫克，每日一次；氯法齐明100毫克，每日一次。
晚期治疗失败（定义为开始治疗90天后血培养仍为阳性）、初始及治疗失败分离株对克拉霉素的敏感性、治疗失败分离株的DNA指纹图谱。
176株基线分离株中有2株（1.1%）对克拉霉素耐药。151例患者接受了MAC菌血症治疗，144例（95%）采用标准方案。在开始治疗后存活超过90天的117例患者中，25例（21%）符合晚期治疗失败标准。在可进行药敏试验的22株治疗失败分离株中，19株（86%）对克拉霉素耐药。因此，采用标准方案治疗的患者中有13%（144例中的19例）出现与克拉霉素耐药相关的治疗失败。采用逻辑回归分析，不依从与治疗失败相关（P = 0.02）。17对可评估的配对分离株中有14对（82%）具有相同的DNA指纹图谱，而3对显示在治疗失败时存在不同的MAC菌株。
在此期间，对克拉霉素的初始耐药很少见。然而，在长期随访中，与克拉霉素耐药出现相关的晚期治疗失败相对常见。大多数晚期治疗失败表现为初始菌株中出现克拉霉素耐药。
