美国的广泛耐药结核病,1993-2007年
N Sarita Shah1, Robert Pratt, Lori Armstrong
1Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, 1600 Clifton Rd, Mailstop E-10, Atlanta, GA 30333, USA.
JAMA
|November 13, 2008
概括
美国广泛耐药结核病 (XDR-TB) 病例有所下降,但仍然令人担忧. 与耐药结核病相比,XDR-TB患者,特别是艾滋病毒感染者,面临着更高的死亡率和更长的感染期.
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:
- 全球广泛耐药结核病 (XDR-TB) 的增加,由于治疗选择有限和死亡率高,造成了重大的公共卫生挑战.
- 了解XDR-TB的流行病学和独特特征对于有效的控制策略至关重要.
研究的目的:
- 分析美国XDR-TB的流行病学.
- 将XDR-TB病例的特征与多抗药性结核病 (MDR-TB) 和对药物敏感性结核病例进行比较.
主要方法:
- 对1993年至2007年期间报告的美国结核病例进行了描述性分析.
- XDR-TB的定义是对特定的一线和二线药物的耐药性,包括异化,利法胺,诺和关键的二线注射药物 (阿米卡,卡纳米或卡普雷米).
主要成果:
- 从1993年到2007年,美国报告了83例XDR-TB病例,观察到下降趋势.
- XDR-TB病例更有可能传播疾病,具有更长的传染期 (MDR-TB的中位数为183天,而MDR-TB为93天),以及较低的培养转化率.
- 与MDR-TB和药物易感结核病相比,XDR-TB病例的死亡率显著高 (35%死亡),特别是在HIV阳性个体 (81%的死亡人数) 中.
结论:
- 尽管报告病例有所下降,但XDR-TB在美国仍在继续出现.
- 改善的结核病和艾滋病毒/艾滋病控制措施可能有助于观察到XDR-TB病例的减少.
- 持续的监测和有针对性的干预措施是有效管理XDR-TB的必要条件.
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