获得性免疫缺陷综合征合并结核病患者对结核分枝杆菌二线药物耐药特征分析

目的了解获得性免疫缺陷综合征（AIDS）合并结核病（TB）患者感染结核分枝杆菌二线药物耐药特点。 方法选取2010年4月至2012年10月于北京大学地坛医院教学医院住院的艾滋病合并结核病患者标本,由中国疾病预防控制中心培养鉴定。进行4种一线药物（异烟肼、利福平、链霉素、乙胺丁醇）和4种二线药物（卷曲霉素、卡那霉素、氧氟沙星、乙硫异烟胺）药敏试验监测,并对所有菌株在gyrA、gyrB、rrs、tlya、eis和ethA基因位点进行DNA测序以检测基因多态性。 结果经培养鉴定共得到31株结核分枝杆菌,其中12株耐卷曲霉素,8株耐氧氟沙星,4株耐卡那霉素,5株耐乙硫异烟胺,耐药率分别为38.71%、25.81%、12.90%和16.13%。7株菌为耐多药菌株,1株菌为广泛耐药菌株,耐药率分别为22.58%和3.23%。耐药菌株最常见的突变位点是rrs₁₄₀₁,gyrA₉₄和gyrA₉₀。一线敏感菌株中氧氟沙星的耐药率显著低于一线耐药菌株（P = 0.012）。性别与结核分枝杆菌耐药差异无统计学意义（P = 0.533）,年龄> 40岁组的氧氟沙星耐药率低于其余两组（P = 0.043）。结核初治组与复治组患者二线耐药率、CD4水平差异无统计学意义（P = 0.333、0.307）。 结论AIDS合并TB患者存在二线抗结核药物原发耐药,其中卷曲霉素耐药率最高,其次是氧氟沙星。     

Antibiotic resistant tuberculosis in the United Kingdom: 1993-1999

BACKGROUND: The re-emergence of tuberculosis as a global health problem over the past two decades, accompanied by an increase in tuberculosis drug resistance, prompted the development of a comprehensive national surveillance system for tuberculosis drug resistance in 1993. METHODS: The UK Mycobacterial Resistance Network (Mycobnet), which includes all mycobacterial reference and regional laboratories in the UK, collects a minimum dataset on all individuals from whom an initial isolate of Mycobacterium tuberculosis complex has been isolated and submitted by source hospital laboratories. Data sought include susceptibility to first line antibiotics, demographic, geographical, and risk factor information. RESULTS: There were 25 217 reports of initial isolates of M tuberculosis complex in the UK between 1993 and 1999. All were tested for sensitivity to isoniazid, rifampicin, and ethambutol and 12 692 of the isolates were also tested for sensitivity to pyrazinamide and streptomycin. A total of 1523 (6.1%) isolates were resistant to one or more drugs, 1397 isolates (5.6%) were resistant to isoniazid with or without resistance to other drugs, and 299 (1.2%) were multidrug resistant. Although the numbers of drug resistant isolates increased over the period, the proportions remained little changed. Certain groups of people were at a higher risk of acquiring drug resistant tuberculosis including younger men, residents of London, foreign born subjects, patients with a previous history of tuberculosis and those infected with HIV. CONCLUSION: Although the proportion of drug resistant tuberculosis cases appears to be stable in the UK at present, more than one in 20 patients has drug resistant disease at diagnosis and more than one in 100 has multidrug resistant disease. Tuberculosis control measures should be strengthened to minimise the emergence of drug resistance through rapid diagnosis, rapid identification of drug resistance, supervised treatment, and maintenance of comprehensive surveillance.     

结核分枝杆菌快速培养和常规药敏试验在脊柱结核治疗中的应用

目的 探讨BACT/ALERT 3D系统快速培养和绝对浓度法药敏试验对指导脊柱结核个体化化疗的应用价值,分析研究脊柱结核耐药情况.方法 根据临床表现、影像学表现、病理检查,50例患者诊断为脊柱结核,并接受手术治疗.收集术中所取脓液、干酪样组织.低温避光保存,8 h内送检,常规处理后接种液体培养基,使用BACT/ALERT 3D系统进行分枝杆菌快速培养.培养阳性者接种PNB和TCH培养基进行菌种鉴定,并将细菌接种至含药改良罗氏培养基,按绝对浓度法进行11种常用一线和二线抗结核药物药敏试验.结果 50例标本培养阳性21例(42%),人型结核杆菌19例,牛型结核杆菌2例.结核杆菌培养和药敏试验平均耗时41 d(28～58 d).其中耐药11例(52.4%),异烟肼耐药4例(19.0%),利福平和乙胺丁醇各1例(4.8%),链霉素3例(14.3%),力克肺疾2例(9.5%),左氧氟沙星8例(38.1%).结论 结核分枝杆菌快速培养和常规药敏试验准确度高,费用低,可检测常用一线和二线药物的敏感性,适用于指导脊柱结核个体化化疗方案的制定.异烟肼、利福平、吡嗪酰胺、乙胺丁醇或(和)链霉素联合用药方案对多数初治脊柱结核患者有效.     

Evidence that rifampicin can be used safely for non-tuberculous diseases

The incidence of primary resistance to rifampicin in Mycobacterium tuberculosis has been analysed in countries where rifampicin is restricted to use for treating tuberculosis and in countries where its use is not restricted. There is no evidence that rifampicin-resistant M tuberculosis strains are more common where the use of the drug is unrestricted. Resistance to rifampicin is less common than is resistance to streptomycin or to isoniazid. We can thus see no danger of producing resistant strains of M tuberculosis if rifampicin therapy is used for short periods for non-tuberculosis infections. The problem of resistance mutants arising in the non-tuberculous species being treated is overcome by combining rifampicin with trimethoprim.     

Rates of drug resistance and risk factor analysis in civilian and prison patients with tuberculosis in Samara Region, Russia

BACKGROUND: Tuberculosis (TB) and HIV rates continue to escalate in Russia, but true rates for drug resistance, especially multidrug resistant tuberculosis (MDR TB), are unknown. A study was conducted with the aims of identifying first line drug resistance, both in the civilian and prison sectors, for new and previously treated cases; and risk factors for the development of drug resistance. METHODS: A cross sectional survey was undertaken of 600 patients (309 civilians, 291 prisoners) with bacteriologically confirmed pulmonary TB over a 1 year period during 2001-2 in Samara Oblast, Russia. RESULTS: The prevalence of isoniazid, rifampicin, streptomycin, ethambutol and pyrazinamide resistance in new TB cases (civilian and prison patients) was 38.0%, 25.2%, 34.6%, 14.7%, and 7.2%, respectively. The prevalence of MDR TB was 22.7%, 19.8%, and 37.3% in all new cases, new civilian cases, and new prison cases, respectively, with an overall prevalence of 45.5% and 55.3% in previously treated cases. Factors associated with resistance included previous TB treatment for more than 4 weeks, smoking (for isoniazid resistance), the presence of cavitations on the chest radiograph, and imprisonment. HIV was not associated with resistance in all patients. The rates of resistance were significantly higher in prisoners, with rate ratios (RR) of 1.9 (95% CI 1.1 to 3.2) for MDR TB, 1.9 (95% CI 1.1 to 3.2) for rifampicin, and 1.6 (95% CI 1.0 to 2.6) for isoniazid. CONCLUSIONS: Rates of first line drug resistance are high, particularly in prisoners and previously treated cases. TB control programmes should initially focus on standardised treatment to maximise cure, combined with measures to reduce institutional TB spread (particularly in prisons) coupled with early diagnosis of MDR TB to reduce the spread and development of resistance.     

馆陶县2012至2014年初治涂阳肺结核患者分枝杆菌培养及耐药

目的调查本县初治涂阳肺结核患者分枝杆菌培养及耐药情况,为分析结核病的防治措施提供依据。 方法选择2012-2014年于本县医院诊治的初治涂阳肺结核患者,在对其进行分枝杆菌培养的基础上,将阳性菌株送至本市相关实验室进行菌种鉴定以及药物敏感性分析。 结果本研究中共收治562例初治涂阳肺结核患者,其中性别比男︰女= 2.23︰1,平均年龄（41.2±3.7）岁;菌群类别：结核分枝杆菌492株（87.54%）,非结核分枝杆菌70株（12.46%）。敏感株为448株（79.72%）,耐药菌株为114株（20.28%）,其中耐多药菌株为36株（6.41%）,单耐药患者以耐链霉素（S）为常见（5.34%）,其次为耐异烟肼（称H）（4.63%）。多耐药中以至少耐异烟肼、链霉素（HS）为常见（22/562,3.91%）,其次为耐异烟肼、利福平（耐HR）（3.73%）。多耐药中耐两药者16例（2.85%）,耐3药者17例（3.02%）,耐4药者3例（0.53%）。耐药顺序为S > H > R > E。 结论中青年男性为肺结核防治的高危人群,需要对其进行密切防控。本县结核分枝杆菌复合群菌株的耐药率虽不高,但初治涂阳患者存在耐多药,需要进一步改进结核病的防控工作。     

Pulmonary tuberculosis among political asylum seekers screened at Heathrow Airport, London, 1995-9

BACKGROUND: Over 50% of cases of tuberculosis (TB) in the UK occur in people born overseas, and new entrants to the country are screened for TB. A study was undertaken to determine the prevalence and disease characteristics of pulmonary TB in new entrants to the UK seeking political asylum. METHODS: A retrospective analysis of the results of screening 53 911 political asylum seekers arriving at Heathrow Airport between 1995 and 1999 was performed by studying Airport Health Control Unit records and hospital medical records. Outcome measures were chest radiograph abnormalities, sputum smear, culture, and drug resistance data for Mycobacterium tuberculosis. RESULTS: The overall prevalence of active TB in political asylum seekers was 241 per 100 000. There were large variations in prevalences of TB between asylum seekers from different regions, with low rates from the Middle East and high rates from the Indian subcontinent and sub-Saharan Africa. The frequency of drug resistance was high; 22.6% of culture positive cases were isoniazid resistant, 7.5% were multidrug resistant (resistant to both isoniazid and rifampicin), and 4% of cases diagnosed with active disease had multidrug resistant TB. CONCLUSIONS: The prevalence rate of TB in political asylum seekers entering the UK through Heathrow Airport is high and more M tuberculosis isolates from asylum seekers are drug resistant than in the UK population. Extrapolating these figures, it is estimated that 101 political asylum seekers with active pulmonary TB enter the UK every year, of whom about 25 would have smear positive disease.     

抗痨药--磁性多孔磷酸三钙陶瓷药物释放系统的实验研究

目的 研制抗痨药——磁性多孔磷酸三钙(A-MPTCP)药物释放系统(DDS)。方法 将MPTCP及多孔磷酸三钙(PTCP)浸于抗痨药溶液，真空、吸附，冻干，制得A-MPTCP及A-PTCP。测定其体外及体内释放抗痨药浓度及持续时间，抑菌试验检测其抗结核分枝杆菌作用。结果 A-MPTCP体外释放异烟肼达36d以上，而A-PTCP为24d；A-MPTCP释放有效浓度链霉素达28d，而A-PTCP为18d。免股骨中维持异烟肼达8周以上，链霉索达6周；2～8周体内取出的A-MPTCP对结核分枝杆菌有明显抑制作用。A-MPTCP体内有良好的骨传导作用。结论 A-MPTCP可望成为治疗骨结核的一种新方法。     

结核患者下呼吸道感染菌群分布及药敏分析

目的探讨肺结核并发下呼吸道感染者病原菌分布特点及耐药性,分析肺结核并发下呼吸道感染的危险因素。方法2011年1月至2013年12月对住院肺结核患者进行细菌分离及药敏试验,分析影响患者下呼吸道感染的危险因素。结果485例肺结核住院患者中并发下呼吸道感染125例（25．77％）,共分离病原菌425株,其中革兰阳性球菌165株（38．82％）,革兰阴性杆菌228株（53．65％）,真菌32株（7．53％）。革兰阳性菌对利奈唑胺敏感性较高,铜绿假单胞菌对氨曲南、头孢他啶及头孢吡肟敏感,肺炎克雷伯菌对头孢吡肟敏感,大肠埃希菌对亚胺培南、派拉西林及环丙沙星敏感性高,鲍曼不动杆菌对常规抗菌药物均表现为耐药。年龄、病程、病灶、抗菌药物应用种类及住院时间是影响肺结核并发下呼吸道感染的危险因素。结论肺结核并发呼吸道感染者细菌耐药性较高,临床应加强对高龄、病程长、病灶多、住院时间长等高危患者的管理,合理应用抗菌药物,加强对患者耐药性观察,可有效降低肺结核并发下呼吸道感染的发病率。     

脊柱结核个体化药物治疗的临床效果观察

目的 探讨药敏试验指导下的脊柱结核个体化药物治疗的临床效果.方法 选择2005年8月至2010年1月诊治的132例脊柱结核手术患者进行结核分枝杆菌培养和药敏试验,随访超过12个月者62例纳入本研究,其中男性37例,女性25例;年龄4～67岁,平均33.6岁.患者均接受手术治疗,术中收集脓液、干酪样组织,常规处理后接种培养液,使用BACT/ALERT 3D细菌自动培养分析系统快速培养,培养阳性者采用改良罗氏培养液按绝对浓度法进行药敏试验,并根据结果制定抗结核化疗方案.术后1、3、6、9、12个月复查各1次,以后每6个月复查1次,观察临床表现及红细胞沉降率、X线片、三维CT、MRI的变化,分析局部及全身结核病转归、术区骨性融合等情况.结果 检测耗时28～58 d,平均42 d;培养阳性率45.2%(28/62).耐药率达24.2%,其中异烟肼12.9%、利福平4.8%、乙胺丁醇3.2%、链霉素9.7%、帕司烟肼6.4%、左氧氟沙星14.5%、利福喷汀1.6%.随访时间12～44个月,平均21个月.术后2周内切口愈合率98.4%(61/62).椎间植骨均获Ⅰ级骨性融合,融合时间8～12个月.结论 耐药结核形势严峻,药敏试验指导下的脊柱结核个体化药物治疗是减少复发、复治的关键.     

Drug resistance patterns in 111 cases of drug-resistant tuberculosis spine

Purpose

We report the largest study conducted till date of drug resistant tuberculosis in spine analyzing the drug susceptibility patterns in 111 cases of proven drug resistance.

Methods

An observed cross-sectional study was conducted. Six-hundred and eighty-six patients with positive cultures underwent sensitivity testing to 13 commonly used anti-tubercular drugs using BACTEC MGIT-960 system.

Results

Females (60.3%) outnumbered males (39.6%). Only three patients (2.7%) were found HIV positive, and none of these had AIDS. Forty-four (39.6%) patients had taken AKT in the past for some form of tuberculosis. Eight (7.2%) patients had history of treatment default. The drug sensitivity testing revealed 87 (78.3%) cases of multi drug resistance (resistance to both isoniazid and rifampicin) and 3 (2.7%) cases of XDR-TB spine. Of the individual drugs, widespread resistance was present to both isoniazid (92.7%) and rifampicin (81.9%), followed by streptomycin (69.3%). Least resistance was found to kanamycin, amikacin and capreomycin.

Conclusion

It is recommended to do routine biopsy, culture and drug sensitivity testing in all patients of tuberculosis spine to guide selection of appropriate second-line drugs when required. In cases of non availability of drug susceptibility testing despite repeated attempts, it is suggested to use data from large series such as this to plan best empirical chemotherapy protocol.

     

脊柱结核耐药性检测及耐药基因PCR-SSCP分析的应用价值

目的了解临床脊柱结核耐药情况,探讨耐药基因PCR-SSCP分析的临床应用价值。方法31例脊柱结核病灶应用BACTECMGIT960培养,所得临床分离株行药敏试验,对耐药基因rpsL、katG、rpoB行PCR-SS-CP分析。结果31例样本中27例培养阳性,其中18株存在不同程度耐药,总耐药率为66.67%。药物耐药率由高至低为链霉素10株(55.56%)、异烟肼8株(44.44%)、利福平7株(38.89%)、PZA3株(16.67%)。耐链霉素株rpsL突变率为70%,耐异烟肼株katG突变率为50%,耐利福平株rpoB突变率为71.43%。高浓度水平耐药株耐药基因突变率明显高于低浓度水平耐药株。结论常规药敏试验与耐药基因分析相结合可能更能准确地反应MTB的耐药情况。     

Combined versus single antituberculosis drugs on the in vitro sensitivity patterns of non-tuberculous mycobacteria.

Drug sensitivity tests were performed for ethambutol, rifampicin, streptomycin, and isoniazid both alone and in paired combinations, on 16 strains of Mycobacterium avium intracellulare, seven strains of Mycobacterium xenopi, and eight strains of Mycobacterium malmoense. Most strains were resistant to the individual drugs, but all strains of M malmoense, 86% of M xenopi, and 31% of M avium intracellulare were completely suppressed by the lowest concentrations of ethambutol and rifampicin when the two drugs were combined in vitro. Streptomycin combined with ethambutol or with rifampicin in the lowest combined concentrations suppressed 50% and 62% respectively of strains of M malmoense. All strains of M xenopi were suppressed by the lowest combined concentrations of streptomycin with rifampicin. Combinations with isoniazid were less effective. It is postulated that similar effects in vivo might account for the satisfactory clinical response seen in patients with disease caused by these mycobacteria who have received treatment with combinations of standard antituberculosis drugs despite in vitro resistance to the individual agents.     

利奈唑胺耐药头状葡萄球菌血流感染菌种及药敏试验分析

目的分析利奈唑胺耐药头状葡萄球菌血流感染菌种及药敏试验结果。 方法2014年1月至2018年1月从2例武汉市中心医院收治的利奈唑胺耐药头状葡萄球菌血流感染者血液标本中分离出4株利奈唑胺耐药头状葡萄球菌作为临床分离株行药敏试验，应用聚合酶链反应（PCR）技术对耐药基因cfr和23S rRNA耐药突变进行检测；应用脉冲场凝胶电泳（PFGE）进行同源性分析。 结果临床分离株对利奈唑胺、诺氟沙星、苯唑西林等常见抗菌药物耐药，对糖肽类、利福平和甲氧苄啶-磺胺甲恶唑敏感；4株耐药菌全部存在23S rRNA基因突变并携带cfr基因。 结论利奈唑胺耐药头状葡萄球菌表现为多重耐药，其原因与23S rRNA基因突变及携带cfr基因有关；留置深静脉导管及长期使用利奈唑胺考虑为耐药菌株血流感染的危险因素。     

人类免疫缺陷病毒/结核分枝杆菌双重感染者结核分枝杆菌分离株一线药物耐药特征

目的分析人类免疫缺陷病毒(HIV)感染者的结核分枝杆菌(MTB)分离株对一线抗结核分枝杆菌药物的耐药特征,为临床治疗HIV/MTB双重感染提供参考依据。 方法选取上海市公共卫生临床中心2012年1月至2016年12月收治的HIV合并MTB感染者154例(实验组)和单纯结核分枝杆菌感染者357例(对照组),进行异烟肼(INH)、利福平(RFP)、乙胺丁醇(EMB)、链霉素(STR)4种一线药物耐药性检测,比较两组患者MTB的总耐药率和总耐多药率,初始及获得性耐药、耐多药率。 结果HIV/MTB双重感染组患者总耐药率(44.2%,68/154)、初始耐药率(42.2%,19/45)、初始耐多药率(13.3%,6/45)、STR总耐药率(31.8%,49/154)和初始耐药率(28.9%,13/45)显著高于单纯结核分枝杆菌感染组(33.9%、25.0%、3.8%、22.7%、11.4%)(P均<0.05)。INH、RFP、EMB耐药率与单纯结核分枝杆菌感染组差异无统计学意义(P均> 0.05)。单纯结核分枝杆菌感染组患者获得性耐药率(39.1%,88/225)和获得性耐多药率(19.1%,43/225)分别高于初始耐药率(25.0%,33/132)和初始耐多药率(3.8%,5/132)(χ²= 16.785、P < 0.001;χ²= 7.393、P = 0.004)。 结论HIV/MTB感染者分离的MTB对一线抗结核分枝杆菌药物耐药率和耐多药率高,其中STR耐药最为严重,提示临床治疗应重视HIV/MTB双重感染者的结核耐药问题,及时采取预防措施和制定个体化治疗方案。     

某院多重耐药菌菌群分布及耐药性分析

目的分析本院2014年5月至2015年4月多重耐药菌菌群分布及耐药性,为临床抗感染治疗提供理论依据。 方法采用法国梅里埃公司生产的Vitek-32型微生物自动分析仪及其配套的鉴定卡进行菌株分离与鉴定,并进行药敏试验,分析多重耐药菌株的来源、菌群分布及其耐药性。 结果共分离多重耐药菌株624株,其中甲氧西林凝固酶阴性葡萄球菌（MRCNS）293株、耐碳青霉烯鲍曼不动杆菌（CRABA）71株、大肠埃希菌（E. coli）57株、肺炎克雷伯菌（KNP）38株、金黄色葡萄球菌（MRSA）34株、耐碳青霉烯铜绿假单胞菌（CRPAE）27株、耐万古霉素肠球菌（VRSE2株以及奇异变形杆菌（PM）2株。阳性球菌中以MRCNS多重耐药所占比例最高（占77.7%）,其次为MRSA（占55.7%）、VRSE最低（占4.5%）;阴性杆菌中E. coli多重耐药最为显著（占68.6%）,其次为CRABA（65.1%）、CRPAE（21.3%）和PM（13.3%）耐药均不显著。耐甲氧西林的葡萄球菌中,MRCNS对环丙沙星（CIP）、庆大霉素（GEN）、青霉素（PEN）、克林霉素（CLI）、米诺环素（MNO）和左氧氟沙星（LVX）的耐药性均显著高于MRSA（χ² = 27.210、77.496、17.341、26.098、10.882、32.475,P均< 0.001）;E. coli、KNP和PM等对亚胺培南（IPM）均100%敏感,对阿米卡星（AMK）、头孢西丁（FOX）和头孢哌酮-舒巴坦（CSL）敏感性也较高;CRPAE与CRABA仅对哌拉西林（PIP）和CSL的耐药率低,对其他抗菌药物耐药性较强。 结论临床多重耐药菌感染发生率日益升高,且耐药机制越来越复杂,导致抗感染疗效受到很大限制。     

Surgical management of multidrug-resistant tuberculosis

We report surgical resections in 3 patients with active multidrug-resistant tuberculosis. All cases involved strains of Mycobacterium tuberculosis resistant to at least isoniazid and rifampin and patients who were poor candidates for medical therapy alone. We conducted pulmonary resections (partial resection in case I, lobectomy in case 2, and segmentectomy in case 3). The optimum multiple-drug regimen, based on drug susceptibility studies, was used preoperatively and postoperatively. In all cases, sputum smears and cultures yielded negative results postoperatively, and continue to be negative for Mycobacterium tuberculosis to date. It is recomended that, if localized disease is present and medical treatment is likely to fail, pulmonary resection be conducted for multidrug-resistant Mycobacterium tuberculosis.     

Surgical management of multidrug-resistant tuberculosis.

We report surgical resections in 3 patients with active multidrug-resistant tuberculosis. All cases involved strains of Mycobacterium tuberculosis resistant to at least isoniazid and rifampin and patients who were poor candidates for medical therapy alone. We conducted pulmonary resections (partial resection in case 1, lobectomy in case 2, and segmentectomy in case 3). The optimum multiple-drug regimen, based on drug susceptibility studies, was used preoperatively and postoperatively. In all cases, sputum smears and cultures yielded negative results postoperatively, and continue to be negative for Mycobacterium tuberculosis to date. It is recommended that, if localized disease is present and medical treatment is likely to fail, pulmonary resection be conducted for multidrug-resistant Mycobacterium tuberculosis.     

Risk factors for multidrug resistant tuberculosis in Europe: a systematic review

BACKGROUND: The resurgence of tuberculosis (TB) in western countries has been attributed to the HIV epidemic, immigration, and drug resistance. Multidrug resistant tuberculosis (MDR-TB) is caused by the transmission of multidrug resistant Mycobacterium tuberculosis strains in new cases, or by the selection of single drug resistant strains induced by previous treatment. The aim of this report is to determine risk factors for MDR-TB in Europe. METHODS: A systematic review was conducted of published reports of risk factors associated with MDR-TB in Europe. Meta-analysis, meta-regression, and sub-grouping were used to pool risk estimates of MDR-TB and to analyse associations with age, sex, immigrant status, HIV status, occurrence year, study design, and area of Europe. RESULTS: Twenty nine papers were eligible for the review from 123 identified in the search. The pooled risk of MDR-TB was 10.23 times higher in previously treated than in never treated cases, with wide heterogeneity between studies. Study design and geographical area were associated with MDR-TB risk estimates in previously treated patients; the risk estimates were higher in cohort studies carried out in western Europe (RR 12.63; 95% CI 8.20 to 19.45) than in eastern Europe (RR 8.53; 95% CI 6.57 to 11.06). National estimates were possible for six countries. MDR-TB cases were more likely to be foreign born (odds ratio (OR) 2.46; 95% CI 1.86 to 3.24), younger than 65 years (OR 2.53; 95% CI 1.74 to 4.83), male (OR 1.38; 95% CI 1.16 to 1.65), and HIV positive (OR 3.52; 95% CI 2.48 to 5.01). CONCLUSIONS: Previous treatment was the strongest determinant of MDR-TB in Europe. Detailed study of the reasons for inadequate treatment could improve control strategies. The risk of MDR-TB in foreign born people needs to be re-evaluated, taking into account any previous treatment.     

Risk factors for multidrug‐resistant tuberculosis in northwest Ethiopia: A case–control study

Ethiopia is one of 30‐high burden multidrug‐resistant tuberculosis (MDR‐TB) countries globally. The aim of this study was to describe the characteristics of patients with MDR‐TB and to investigate risk factors for MDR‐TB relative to having drug‐susceptible tuberculosis (TB), in northwest Ethiopia. A hospital‐based, unmatched case–control study was conducted. Cases were all MDR‐TB patients (i.e., resistant to at least rifampicin and isoniazid) who were confirmed by culture and drug‐susceptibility testing whilst enrolled on treatment at Gondar University Hospital. Controls were all drug‐susceptible tuberculosis (DS‐TB) patients who were confirmed by Gene Xpert MTB/RIF at Gondar University Hospital. Univariable and multivariable logistic regression models were used for comparisons, and odds ratios with 95% confidence intervals (CI) were computed to measure the strength of association between the dependent and independent variables. A total of 452 patients (242 MDR‐TB and 210 DS‐TB) were included in this study. The mean age of the study participants was 33 years (SD ± 14 years). Approximately one‐fifth (78, 17%) of all study participants were human immunodeficiency virus (HIV) positive; 21% (51) of cases and 13% (27) of controls. Risk factors associated with MDR‐TB were a history of previous TB treatment (Adjusted Odds Ratio (AOR): 83.8; 95% CI: 40.7, 172.5), low educational status (AOR: 5.32; 95% CI: 1.43, 19.81); and ages less than 20 years (AOR: 9.01; 95% CI: 2.30, 35.25) and 21–30 years (AOR: 2.61; 95% CI: 1.02, 6.64). HIV infection was also significantly associated with MDR‐TB among new TB patients (AOR: 5.55; 95% CI: 1.17, 26.20). This study shows that clinical and demographic features can be used to indicate higher risks of drug resistance in this setting.