论文部分内容阅读
背景:荷兰。目的:调查不同地理来源的耐多药结核病人耐二线药情况及其相关因素。方法:对荷兰1993年1月至2007年10月间耐多药结核病人分离菌株的实验室数据进行回顾性研究。结果:发现的153例耐多药结核病人中,18例(12%)为荷兰本国人。对其中的131例进行二线药物敏感性实验,有28例(21%)为耐二线药,且大部分为单一耐药(24/28(86%));9例耐丙硫异烟胺(PTH),6例耐对氨基水杨酸,4例耐阿米卡星(ASK),4例耐环丙沙星,1例耐环丝氨酸)。有4例耐多药结核病人耐多种二线药;2例为广泛耐药的牛型结核分枝杆菌。在所有耐多药结核病人中,来自欧洲和中亚者二线耐药较普遍,且涉及的药物也较广泛。来自非洲和美洲者主要耐PTH,而来自东南亚者主要耐AMK。结论:在荷兰,耐多药结核病人中二线耐药情况并不普遍。大部分二线耐药发生在移民当中,来源于不同的地域,病人耐药情况也不同。
Background: Netherlands. Objective: To investigate the resistance to second-line drugs and related factors in multidrug-resistant tuberculosis patients from different geographical origins. METHODS: A retrospective study was conducted on laboratory data from isolates of MDR-TB patients from January 1993 to October 2007 in the Netherlands. Results: Of the 153 MDR-TB cases found, 18 (12%) were Dutch nationals. Thirty-two of these 131 patients were tested for second-line drug susceptibility, 28 (21%) were resistant to second-line drugs and most were single-drug resistant (24/28; 86% PTH), 6 anti-paracetamol, 4 anti-amikacin (ASK), 4 anti-ciprofloxacin and 1 anti-cycloserine. Four MDR-TB patients were resistant to multiple second-line drugs and two were extensively drug-resistant M. bovis. Among all those with multidrug-resistant tuberculosis, second-line resistance from Europe and Central Asia is more common and the drugs involved are broader. PTHs are predominantly from Africa and the Americas, while those from Southeast Asia are mostly resistant to AMKs. Conclusions: Second-line resistance in MDR-TB patients is not common in the Netherlands. Most second-line resistance occurs among immigrants, from different geographical areas, and patient resistance is also different.