Effect of drug resistance on the generation of secondary cases of tuberculosis

被引:84
作者
Burgos, M
DeRiemer, K
Small, PM
Hopewell, PC
Daley, CL
机构
[1] Stanford Univ, Med Ctr, Dept Med, Div Infect Dis & Geog Med, Stanford, CA 94305 USA
[2] San Francisco Gen Hosp, Div Pulm & Crit Care Med, San Francisco, CA 94110 USA
[3] Univ Calif San Francisco, San Francisco, CA 94143 USA
关键词
D O I
10.1086/379895
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background. The results of animal studies suggest that isoniazid-resistant strains of Mycobacterium tuberculosis are less pathogenic than isoniazid-susceptible strains. Here, we assess the relative pathogenicity of drug-resistant and drug-susceptible strains, in a human population. Methods. We linked IS6110 genotype patterns of M. tuberculosis strains with drug-susceptibility test results and epidemiologic information for 85% of culture-positive incident cases of tuberculosis (TB) in San Francisco during 1991-1999. We assumed that drug-susceptible and drug-resistant strains were transmitted to secondary case patients if the drug-resistance and genotype patterns were identical. We calculated the number of secondary cases for each drug-resistance pattern and determined the relative secondary-case rate ratio (SR) of drug-resistant TB,to drug-susceptible TB. Results. There were 1800 patients with culture-positive TB, drug-susceptibility test results, and genotyping results. The overall SR of drug-resistant to drug-susceptible TB cases was 0.51 (95% confidence interval [CI], 0.37-0.69). The SR was 0.29 (95% Cl, 0.15-0.57) for isoniazid-resistant strains, 0.10 (95% Cl, 0.02-0.42) for strains resistant to both isoniazid and streptomycin, and 0.88 (95% Cl, 0.53-1.47) for streptomycin-resistant strains. There were no secondary cases caused by multidrug-resistant (MDR) TB. The SR for rifampin-resistant cases was 2.33 (95% Cl, 1.04-5.25). Seventy-eight percent (7/9) of the patients with rifampin-resistant secondary cases of TB were scropositive for human immunodeficiency virus. Conclusion. In the context of an effective TB program in San Francisco, strains that were resistant to isoniazid either alone or in combination with other drugs were less likely to result in secondary cases than were drug-susceptible strains. In this setting, isoniazid-resistant and MDR TB cases were not likely to produce new, incident drug-resistant TB cases.
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页码:1878 / 1884
页数:7
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