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Objective:To investigate the risk and efficacy of the decortication in treatment of drug-resistant tuberculous empyema.Methods:A retrospective analysis was conducted on the 146 patients with tuberculous empyema, who underwent decortication in Wuhan Pulmonary Hospital from March 2016 to November 2018, according to the drug-susceptibility testing of the pleural effusion or tissue specimens, the patients had been divided into drug-resistant group(29 cases) and control group(117 cases), compared the clinical datas such as operation time, intraoperative blood loss, postoperative drainage duration, pulmonary reexpansion duration, postoperative complications and curative ratio between both groups, and the factors that influence the risk and efficacy of surgery had been analyzed.Results:The operative time, intraoperative blood loss, postoperative drainage duration and postoperative complications in the drug-resistant group were larger than those in the control group, and the differences were statistically significant ( P<0.05). There was no significant difference in pulmonary reexpansion duration and curative ratio in the two groups( P>0.05). Conclusion:Decortication is safety, effective and feasible in the treatment of drug-resistant tuberculous empyema, although the operation is difficult and risky.
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Resumen: OBJETIVO Evaluar la sensibilidad y valores predictivos de BAAR-Ziehl-Neelsen y GeneXpert (MTB/RIF) en muestras respiratorias y no respiratorias en población general y con VIH. MATERIAL Y MÉTODO Estudio clínico abierto, sin distribución al azar, prospectivo, descriptivo y observacional efectuado de mayo de 2016 a enero de 2017. Los criterios de inclusión fueron: pacientes con datos clínicos epidemiológicos radiológicos que sugirieran tuberculosis en la evaluación diagnóstica o riesgo de padecerla. Se hizo toma simultánea de expectoración o muestra extrapulmonar para determinación de BAAR-Ziehl-Neelsen, GeneXpert MTB y cultivo; se utilizó como patrón de referencia el cultivo. RESULTADOS Se incluyeron en el estudio 120 pacientes, 88 (73.3%) hombres. La justificación de la realización de la prueba fue enfermedad aguda grave 76 (63.3%), el factor de riesgo de mayor prevalencia fue el VIH-SIDA 54 (45.5%). El mayor porcentaje correspondió a la forma respiratoria (n = 75, 62.5%). El total de las muestras (n = 89, 74.2%) fueron negativas respecto a BAAR en contraste con GeneXpert y cultivo, que fueron positivos en 94 casos (78.3%). CONCLUSIONES Los indicadores estables evaluados en la prueba GeneXpert mostraron que es una prueba útil, sobre todo en muestras extrapulmonares de pacientes con VIH-SIDA.
Abstract: OBJECTIVE To assess the sensitivity and predictive values of BAAR Ziehl-Neelsen and GeneXpert (MTB/RIF) for respiratory and non-respiratory samples in the general population and HIV-patients. MATERIAL AND METHOD A clinical open, not-random, prospective, descriptive and observational study was done from May 2016 to January 2017. Inclusion criteria were: Patients with radiological, clinical and epidemiological data that suggested tuberculosis within the diagnostic evaluation or risk of having it. Simultaneous sputum or extrapulmonary sample was taken for determination of Ziehl-Neelsen, GeneXpert MTB and culture; the crop was used as a gold standard. RESULTS There were included 120 patients, 88 (73.3%) men; the justification for performing the test was severe acute disease (n = 76, 63.3%), the risk factor with the highest prevalence was HIV-AIDS (n = 54, 45.5%) The highest percentage was respiratory (n = 75, 62.5%). The total of samples 89 (74.2%) were negative with respect to BAAR in contrast to GeneXpert and culture, which reported positive in 94 (78.3%). CONCLUSIONS The stable indicators evaluated in the GeneXpert test showed that it is a useful test especially in extralung samples of patients with HIV-AIDS.
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BACKGROUND: We analyzed the prevalence of anti-tuberculosis drug resistance in Mycobacterium tuberculosis isolates from respiratory specimens of patients with newly diagnosed and previously treated tuberculosis. METHODS: From February 2010 to July 2010, a total of 542 M. tuberculosis clinical isolates were collected from pulmonary tuberculosis patients in six university hospitals distributed throughout Korea. We analyzed the results of anti-tuberculosis drug resistance tests according to treatment history and geographic location. RESULTS: Among the 542 isolates, 473 (87.3%) were from newly diagnosed cases and 69 (12.7%) were from previously treated cases. The rates of multi-drug resistance (MDR), fluoroquinolone (ofloxacin, levofloxacin, and moxifloxacin) resistance, and extensive drug resistance (XDR) were 3.8%, 1.1-1.5%, and 0%, respectively, in new cases, and 21.7%, 13.0-17.4%, and 4.3%, respectively, in previously treated cases. In the previously treated cases, the proportions of XDR-TB in MDR-TB were 20% (3/15). The resistance rates were variable according to geographic location. CONCLUSION: As the anti-tuberculosis drug resistance rates are much higher in newly diagnosed cases than in previously treated patients, efforts should be made to ensure that tuberculosis treatment is successful. In addition, before the selection of an anti-tuberculosis drug treatment for previously treated patients, the susceptibility test results, including to fluoroquinolone, should be verified.
Subject(s)
Humans , Dietary Sucrose , Drug Resistance , Drug Resistance, Multiple , Extensively Drug-Resistant Tuberculosis , Hospitals, University , Korea , Mycobacterium , Mycobacterium tuberculosis , Ofloxacin , Prevalence , Tuberculosis , Tuberculosis, PulmonaryABSTRACT
La tasa de notificación de tuberculosis pulmonar bacilífera en 2001 en Buenaventura, Colombia, fue de 66 por 100.000 habitantes. El pobre control de la tuberculosis en este municipio durante los últimos 10 años y el uso inadecuado de medicamentos de primera línea hace sospechar una elevada resistencia a estas drogas antituberculosas. En este artículo se presentan y discuten los resultados de dos encuestas de resistencia inicial a drogas antituberculosas de primera línea en personas con tuberculosis pulmonar realizadas en Buenaventura entre el 1° de agosto de 1997 y el 31 de enero de 1998, y entre el 15 de noviembre de 2000 y el 15 de noviembre de 2001, con un intervalo de dos años y nueve meses. En las dos encuestas se utilizó el método de proporciones múltiples. Se logró aislar Mycobacterium tuberculosis en 93% y 55% de los casos nuevos de tuberculosis pulmonar diagnosticados en cada uno de los periodos estudiados. La resistencia inicial a cualquier medicamento antituberculoso fue de 25% (9/36) y 32% (23/72) en la primera y segunda encuesta, respectivamente. La multirresistencia inicial (definida como resistencia, al menos, a isoniacida y rifampicina) fue de 6% en ambas encuestas. Este porcentaje de resistencia encontrado demuestra la diseminación de cepas multirresistentes y destaca a la vigilancia epidemiológica de la resistencia a drogas antituberculosas como un componente esencial en el control de la enfermedad, por lo menos, en las zonas en las que el programa ha sido errático en el pasado. De esta manera, se podrán identificar las áreas en las que la estrategia DOTS deba ser reforzada con el uso de drogas de segunda línea (DOTS-plus).
In 2001, Buenaventura, Colombia, the rate of smear-positive pulmonary tuberculosis was of 66 per 100.000 inhabitants. The poor control of the tuberculosis in this city during the last 10 years and the inadequate use of first-line anti-tuberculosis drugs was an opportune situation for the development of high resistance to these drugs. Two surveys of initial resistance to first-line antituberculosis drugs were conducted in new cases of pulmonary TB, in the city of Buenaventura-the first from August 1, of 1997 to January 31 of 1998 and the second from November 15, of 2000 to November 15, 2001. The method of multiple proportions was used to determine drug susceptibility. Mycobacterium tuberculosis was isolated in 93% and 55% of the new cases of lung TB during each respective period. The initial resistance to at least one drug was 25% (9/ 36) and 32% (23/72), respectively. The initial multi-drug resistance (defined as resistance to at least isoniazid and rifampicin) was 6% for both surveys. This demonstrates the dissemination of multidrug-resistant bacilli and shows the need for surveillance of resistance to antituberculosis drugs in control of the disease, particularly in those areas where the TB control program has been erratically applied. In areas where multi-drug resistant TB occurs, the control strategy should be enhanced with the careful introduction of second-line drugs.