Extensive Drug Resistance Acquired During Treatment of Multidrug-Resistant Tuberculosis

被引：127

作者：

Cegielski, J. Peter ^{[1
]}

Dalton, Tracy ^{[1
]}

Yagui, Martin ^{[2
]}

Wattanaamornkiet, Wanpen ^{[3
]}

Volchenkov, Grigory V. ^{[4
]}

Via, Laura E. ^{[5
]}

Van der Walt, Martie ^{[6
]}

Tupasi, Thelma ^{[7
]}

Smith, Sarah E. ^{[1
]}

Odendaal, Ronel ^{[6
]}

Leimane, Vaira ^{[8
]}

Kvasnovsky, Charlotte ^{[1
]}

Kuznetsova, Tatiana ^{[4
]}

Kurbatova, Ekaterina ^{[1
]}

Kummik, Tiina ^{[9
]}

Kuksa, Liga ^{[8
]}

Kliiman, Kai ^{[9
]}

Kiryanova, Elena V. ^{[10
]}

Kim, HeeJin ^{[11
]}

Kim, Chang-ki ^{[11
]}

Kazennyy, Boris Y. ^{[10
]}

Jou, Ruwen ^{[12
]}

Huang, Wei-Lun ^{[12
]}

Ershova, Julia ^{[1
]}

Erokhin, Vladislav V. ^{[13
]}

Diem, Lois ^{[1
]}

Contreras, Carmen ^{[14
]}

Cho, Sang Nae ^{[15
,16
]}

Chernousova, Larisa N. ^{[13
]}

Chen, Michael P. ^{[1
]}

Campos Caoili, Janice ^{[7
]}

Bayona, Jaime ^{[14
]}

Akksilp, Somsak ^{[3
]}

机构：

[1] Ctr Dis Control & Prevent, Atlanta, GA 30333 USA

[2] Natl Inst Hlth, Lima, Peru

[3] Minist Publ Hlth, Dept Dis Control, Bangkok, Thailand

[4] Vladimir Oblast TB Dispensary, Vladimir, Russia

[5] NIAID, NIH, Bethesda, MD 20892 USA

[6] MRC, Pretoria, South Africa

[7] Trop Dis Fdn, Manila, Philippines

[8] Riga East Univ Hosp Ctr TB & Lung Dis, Riga, Latvia

[9] Tartu Univ Hosp, Tartu, Estonia

[10] Orel Oblast TB Dispensary, Oryol, Russia

[11] Korean Inst TB, Seoul, South Korea

[12] Taiwan Ctr Dis Control, Taipei, Taiwan

[13] Russian Acad Med Sci, Cent TB Res Inst, Moscow 109801, Russia

[14] Socios Salud Sucursal, Lima, Peru

[15] Int TB Res Ctr, Chang Won, South Korea

[16] Yonsei Univ, Coll Med, Seoul, South Korea

来源：

CLINICAL INFECTIOUS DISEASES | 2014年 / 59卷 / 08期

关键词：

tuberculosis; multidrug-resistant tuberculosis; extensively drug-resistant tuberculosis; Green Light Committee; PROPENSITY SCORE; HEALTH;

D O I：

10.1093/cid/ciu572

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

071005 [微生物学]; 100108 [医学免疫学];

摘要：

Background. Increasing access to drugs for the treatment of multidrug-resistant (MDR) tuberculosis is crucial but could lead to increasing resistance to these same drugs. In 2000, the international Green Light Committee (GLC) initiative began to increase access while attempting to prevent acquired resistance. Methods. To assess the GLC's impact, we followed adults with pulmonary MDR tuberculosis from the start to the end of treatment with monthly sputum cultures, drug susceptibility testing, and genotyping. We compared the frequency and predictors of acquired resistance to second-line drugs (SLDs) in 9 countries that volunteered to participate, 5 countries that met GLC criteria, and 4 countries that did not apply to the GLC. Results. In total, 832 subjects were enrolled. Of those without baseline resistance to specific SLDs, 68 (8.9%) acquired extensively drug-resistant (XDR) tuberculosis, 79 (11.2%) acquired fluoroquinolone (FQ) resistance, and 56 (7.8%) acquired resistance to second-line injectable drugs (SLIs). The relative risk (95% confidence interval [CI]) of acquired resistance was lower at GLC-approved sites: 0.27 (.16-.47) for XDR tuberculosis, 0.28 (.17-.45) for FQ, and 0.15 (.06-.39) to 0.60 (.34-1.05) for 3 different SLIs. The risk increased as the number of potentially effective drugs decreased. Controlling for baseline drug resistance and differences between sites, the odds ratios (95% CIs) were 0.21 (.07-.62) for acquired XDR tuberculosis and 0.23 (.09-.59) for acquired FQ resistance. Conclusions. Treatment of MDR tuberculosis involves substantial risk of acquired resistance to SLDs, increasing as baseline drug resistance increases. The risk was significantly lower in programs documented by the GLC to meet specific standards.

引用

页码：1049 / 1063

页数：15

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