Extensive drug resistance acquired during treatment of multidrug-resistant tuberculosis.

Autor:	Cegielski JP; Centers for Disease Control and Prevention, Atlanta, Georgia., Dalton T; Centers for Disease Control and Prevention, Atlanta, Georgia., Yagui M; National Institute of Health, Lima, Peru., Wattanaamornkiet W; Department of Disease Control, Ministry of Public Health, Bangkok, Thailand., Volchenkov GV; Vladimir Oblast Tuberculosis Dispensary, Russian Federation., Via LE; National Institute for Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland., Van Der Walt M; Medical Research Council, Pretoria, Republic of South Africa., Tupasi T; Tropical Disease Foundation, Manila, Republic of the Philippines., Smith SE; Centers for Disease Control and Prevention, Atlanta, Georgia., Odendaal R; Medical Research Council, Pretoria, Republic of South Africa., Leimane V; Riga East University Hospital Centre of Tuberculosis and Lung Diseases, Latvia., Kvasnovsky C; Centers for Disease Control and Prevention, Atlanta, Georgia., Kuznetsova T; Vladimir Oblast Tuberculosis Dispensary, Russian Federation., Kurbatova E; Centers for Disease Control and Prevention, Atlanta, Georgia., Kummik T; Tartu University Hospital, Estonia., Kuksa L; Riga East University Hospital Centre of Tuberculosis and Lung Diseases, Latvia., Kliiman K; Tartu University Hospital, Estonia., Kiryanova EV; Orel Oblast Tuberculosis Dispensary, Russian Federation., Kim H; Korean Institute of Tuberculosis, Seoul, Republic of Korea., Kim CK; Korean Institute of Tuberculosis, Seoul, Republic of Korea., Kazennyy BY; Orel Oblast Tuberculosis Dispensary, Russian Federation., Jou R; Taiwan Centers for Disease Control, Taipei., Huang WL; Taiwan Centers for Disease Control, Taipei., Ershova J; Centers for Disease Control and Prevention, Atlanta, Georgia., Erokhin VV; Central Tuberculosis Research Institute, Russian Academy of Medical Sciences, Moscow., Diem L; Centers for Disease Control and Prevention, Atlanta, Georgia., Contreras C; Socios en Salud Sucursal, Lima, Peru., Cho SN; International Tuberculosis Research Center, Changwon Yonsei University College of Medicine, Seoul, Republic of Korea., Chernousova LN; Central Tuberculosis Research Institute, Russian Academy of Medical Sciences, Moscow., Chen MP; Centers for Disease Control and Prevention, Atlanta, Georgia., Caoili JC; Tropical Disease Foundation, Manila, Republic of the Philippines., Bayona J; Socios en Salud Sucursal, Lima, Peru., Akksilp S; Department of Disease Control, Ministry of Public Health, Bangkok, Thailand.
Jazyk:	angličtina
Zdroj:	Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2014 Oct 15; Vol. 59 (8), pp. 1049-63. Date of Electronic Publication: 2014 Jul 23.
DOI:	10.1093/cid/ciu572
Abstrakt:	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. (Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2014. This work is written by (a) US Government employee(s) and is in the public domain in the US.)
Databáze:	MEDLINE
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