Palmieri F, Pellicelli A M, Girardi E, Rianda A, Bordi E, Festa A, Catania S, D'Amato C
II Divisione, IRCCS L. Spallanzani di Roma.
Ann Ital Med Int. 1998 Jul-Sep;13(3):139-45.
A retrospective chart review was performed on 118 HIV infected patients with pulmonary tuberculosis hospitalized between 1987 and 1996 in a tertiary care center for Infectious Diseases in Rome. The aims of this study were: a) to evaluate global prevalence of and risk factors for drug-resistant Mycobacterium tuberculosis and multidrug resistant tuberculosis; b) to assess trends in prevalence of drug-resistant tuberculosis over the 10-year study period. Prevalence of drug resistance of first Mycobacterium tuberculosis isolates was tested on Lowenstein-Jensen medium with the proportional method. Of the 118 patients studied, 83 had never been treated for tuberculosis and 35 had already been treated for at least 1 month. The overall prevalence of resistance to one or more drugs was 25% (17% in never treated patients vs 46% in already treated patients; p = 0.002). Five percent of isolates were resistant to both isoniazid and rifampin (1% in never treated patients vs 14% in already treated patients; p = 0.008). Resistance rates to individual drugs were: isoniazid 14%, rifampin 8%, ethambutol 0%, streptomycin 13%. During the study period no significant variations in prevalence of drug-resistant tuberculosis were found. In our area, empiric therapy should include 4 drugs: as well as isoniazid, rifampin and pyrazinamide, we recommend ethambutol. Surveillance of drug-resistant tuberculosis is needed. Directly observed therapy should be considered for HIV patients in order to prevent increases in drug resistance, relapses, and treatment failures.
对1987年至1996年间在罗马一家传染病三级护理中心住院的118例感染人类免疫缺陷病毒（HIV）并患有肺结核的患者进行了回顾性病历审查。本研究的目的是：a）评估耐多药结核分枝杆菌和耐多药结核病的总体患病率及危险因素；b）评估10年研究期间耐多药结核病患病率的趋势。采用比例法在罗-琴培养基上检测首批结核分枝杆菌分离株的耐药率。在118例研究患者中，83例从未接受过结核病治疗，35例已接受过至少1个月的治疗。对一种或多种药物耐药的总体患病率为25%（未治疗患者中为17%，已治疗患者中为46%；p = 0.002）。5%的分离株对异烟肼和利福平均耐药（未治疗患者中为1%，已治疗患者中为14%；p = 0.008）。对个别药物的耐药率分别为：异烟肼14%，利福平8%，乙胺丁醇0%，链霉素13%。在研究期间，未发现耐多药结核病患病率有显著变化。在我们地区，经验性治疗应包括4种药物：除异烟肼、利福平和吡嗪酰胺外，我们建议加用乙胺丁醇。需要对耐多药结核病进行监测。对于HIV患者应考虑采用直接观察治疗，以防止耐药性增加、复发和治疗失败。
