ABSTRACT
ObjectiveTo investigate the anti-tuberculosis treatment response and outcomes in treatment naive patients infected with multidrug-resistant tuberculosis (MDR-TB).MethodsA total of 408 patients who were diagnosed with MDR-TB in Shanghai Pulmonary Hospital from January 2006 to January 2009 were recruited in this study.These patients were divided into two groups based on their previous treatment history:treatment naive group and re treatment group. The treatment response,outcomes andadverse eventswere observed. The outcomes of thesetwo groupswere compared by cohort analysis and x2 test.ResultsThe sputum conversion rates,the lesions absorption rate and the cavity closing or shrinking rate of the treatment naive MDR TB group were significantly higher than those of the re treatment group,while the adverse events rate was not significantly different between two groups (x2 =0.434,P＞0.05).Among 89 treatment naive cases,66 cases (74.16％) were cured,8(8.99％) completed the full treatment course,7(7.87％) were treatment failure,3(3.37％) died,and 5(5.62％) were lost to follow-up.Among the 319 cases of re-treatment MDR TB group,134 (42.01％) were cured,31(9.72％) completed the full treatment course,116 (36.36％) were treatment failure,12(3.76％) died,26(8.15％) were lost to follow-up.The cure rate of the treatment naive MDR-TB group was significantly higher than that of re-treatment group (x2=28.783,P＜0.01).The factors influencing the treatment outcomes included the stage of the disease,the range of lesions and cavity, the patients'generalnutritional status, underlying complications,and the drug-resistant strains. Conclusions The anti-tuberculosis treatment outcomes are better in treatment naive patients with MDR-TB infection compared to the treatment experienced and retreated patients.Therefore,the status of the drug resistance should be closely monitored in order to detect MDR-TB as early as possible.With the early diagnosis,the treatmcnt regimen may be modified timely and as a result the treatment outcomes can be improved.
ABSTRACT
Objective To investigate the resistant patterns of Mycobacterium tuberculosis (MTB) strains against first- and second-line anti-tuberculosis drugs. Methods Drug susceptibility tests of 518 MTB strains collected from January 2008 to March 2009 were performed using BactecMGIT 960. The data were analyzed by chi square test. ResultsIn 518 strains, 168 (32.44％) were all sensitive to all seven drugs, 350 (67.56％) were resistant to at least one drug. Among all strains, 72 (13.90％) were resistant to one drug, 24 (4.63％) were resistant to two drugs, 254 (49.03％) were resistant to three or more drugs. A total of 217 strains (41.89 ％) were classified as multi-drug resistant tuberculosis (MDR-TB)strains and 65(12.55％)were extensively drug resistant tuberculosis (XDR-TB) strains which accounted for 29.95 ％ of MDR-TB strains. The drug resistant rate of isoniazid which belonged to first-line drugs was 53.67％ (278 strains) and that of ofloxacin which belonged to second-line drugs was 39.77 ％ (206 strains). In 433 retreated patients, the drug resistant rate against any drugs, MDR rate and XDR rate were 72.05％, 46.42％ and 13.86％,respectively, which were all higher than those in treatment naive patients (44.70％, 18. 82％ and 5.88％, respectively; x2 = 24. 253, x2 ＝ 22. 229 and x2 ＝ 4. 117, respectively; all P ＜ 0.01).ConclusionsThe resistant rate of MTB is high in a tuberculosis specialized hospital in Shanghai, and MDR-TB also shares a high resistant rate as well as XDR-TB. Furthermore, drug resistance is more common in retreated patients.
ABSTRACT
Objective To understand the bacteriology and the association between drug susceptibility and clinical features from recent hospitalization of tuberculosis(TB)patients with positive tuberculosis bacilli culture.Methods We collected the clinical data of inpatients due to tuberculosis or pulmonary disease with positive tuberculosis bacilli by BACTEC960 culture auto-analysis system and possessing anti-tuberculosis drug susceptibility testing results from January 2008 to November 2008.All isolated strains were tested with first-line drugs included Streptomycin(S),Isoniazid(H),Rifampicin(R)and Ethambutol(E).Some isolate strains were used to test Amikacin(Am),Capreomycin(Cm)and Ofloxacin(Ofx).We recorded the drug-tested results and clinical data and retrospectively analyzed them.The patients with pulmonary disease from nontuberculosis mycobacteria(NTM)were excluded.Results (1)There were 417 patients with positive culture of tuberculosis bacilli (included 294 male and 123 female).The mean age was(47.8 18.1)years(ranging from 6 to 91 years).There were 68 cases complicated with endobronchial tuberculosis(EBTB)and 56 cases with type 2 diabetes mellitus.(2)There were 271 cases for initial treatment and 146 cases of relapsing tuberculosis.The total drug resistant rate was 53.5 percent,and of oflx was as high as 31.86 percent.The initial drug resistant rate was S 22.5%,H 25.8%,R 17.3%,E 21.0%,Am 6.3%,Cm 10.0%,Ofx 16.6% respectively and the required rate was 67.8%,82.9%,68.5%,68.5%,19.9%,25.3%,58.2% respectively.(3)There were 143 patients with multi-drug resistant TB(MDR-TB).The mean age 44.59?16.31 was significantly younger than of other patients(P