加利福尼亚州结核病患者的多种药物耐药性,1994-2003年
Reuben M Granich1, Peter Oh, Bryan Lewis
1Division of TB Elimination, National Center for HIV, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Ga, USA. granichrm@state.gov
JAMA
|June 9, 2005
概括
多药耐药结核病 (MDR-TB) 仍然是加利福尼亚的一个持续威胁,尽管有控制努力,但仍影响1.4%的病例. 关键的风险因素包括以前的结核病治疗和最近的移民,观察到治疗完成率较低.
科学领域:
- 公共卫生 公共卫生
- 传染性疾病 传染性疾病
- 流行病学 流行病学
背景情况:
- 加利福尼亚州的结核病 (TB) 病例在1994年至2003年期间下降了33%.
- 尽管总体下降,但加利福尼亚州在2003年报告了全国最高的结核病例数量.
- 在过去十年中,多耐药结核病 (MDR-TB) 病例的比例保持不变.
研究的目的:
- 分析加利福尼亚州MDR-TB的流行,趋势,地理分布,临床特征,风险因素和结果.
- 为了检查1994年至2003年期间报告的38291起结核病例,遍及加利福尼亚州所有61个卫生管辖区.
- 多抗药性结核病被定义为对异化和利法的耐药性.
主要方法:
- 进行了单变量和多变量分析.
- 数据是从加利福尼亚州结核病确诊病例报告登记处提取的.
- 通过统计模型识别了与MDR-TB相关的因素.
主要成果:
- 检测到的结核病例中有1.4% (407/28,712) 是MDR-TB,随着时间的推移,比例没有显著变化 (P = .87).
- 多抗药性结核病例更有可能出现腔腔病变 (2x) 和先前结核病治疗 (7x).
- 多抗药性结核病患者的治疗完成率明显较低 (67%与非多抗药性结核病相比).
结论:
- 尽管采取了控制措施,但MDR-TB在加利福尼亚州的病例中仍然占1-2%.
- 治疗选择有限和与MDR-TB相关的高成本需要持续努力.
- 加强本地和全球结核病控制战略对于预防MDR-TB的发展和传播至关重要.
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