Later emergence of acquired drug resistance and its effect on treatment outcome in patients treated with Standard Short-Course Chemotherapy for tuberculosis

BMC Pulmonary Medicine

Research Article

Liang Li¹  Yan Ma¹  Jingtao Gao¹  Jian Du¹  Qi Li¹  Daiyu Hu²  Feiying Liu³  Shouyong Tan⁴  Lianying Zhang⁵  Liping Ma⁶  Xiangqun Li⁷  Yanyong Fu⁸  Yanling Zhang⁹  Guofeng Zhu^1,10 

[1] Clinical Center on Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China;Department of TB Control, Chongqing Anti-tuberculosis Institute, Chongqing, China;Department of TB Control, Guangxi Center for Disease Control and Prevention, Nanning, Guangxi, China;Department of TB Control, Guangzhou Chest Hospital, Guangzhou, Guangdong, China;Department of TB Control, Hebei Center for Disease Control and Prevention, Shijiazhuang, Hebei, China;Department of TB Control, Henan Center for Disease Control and Prevention, Zhengzhou, Henan, China;Department of TB Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China;Department of TB Control, Tianjin Centers for Disease Control and Prevention, Tianjin, China;Department of TB Control, Yunnan Center for Disease Control and Prevention, Kunming, Yunnan, China;State Key Laboratory for Molecular Virology and Genetic Engineering, Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China;

关键词: Tuberculosis;    Multi-Drug Resistant Tuberculosis;    Standard Short-Course Chemotherapy;    Acquired drug resistant tuberculosis emergence;   

DOI  :  10.1186/s12890-016-0187-3

 received in 2015-12-07, accepted in 2016-01-22,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundsThe failure of current Standard Short-Course Chemotherapy (SCC) in new and previously treated cases with tuberculosis (TB) was mainly due to drug resistance development. But little is known on the characteristics of acquired drug resistant TB during SCC and its correlation with SCC failure. The objective of the study is to explore the traits of acquired drug resistant TB emergence and evaluate their impacts on treatment outcomes.MethodsA prospective observational study was performed on newly admitted smear positive pulmonary TB (PTB) cases without drug resistance pretreatment treated with SCC under China’s National TB Control Program (NTP) condition from 2008 to 2010. Enrolled cases were followed up through sputum smear, culture and drug susceptibility testing (DST) at the end of 1, 2, and 5 months after treatment initiation. The effect factors of early or late emergence of acquired drug resistant TB , such as acquired drug resistance patterns, the number of acquired resistant drugs and previous treatment history were investigated by multivariate logistic regression; and the impact of acquired drug resistant TB emergence on treatment failure were further evaluated.ResultsAmong 1671 enrolled new and previously treated cases with SCC, 62 (3.7 %) acquired different patterns of drug resistant TB at early period within 2 months or later around 3–5 months of treatment. Previously treated cases were more likely to develop acquired multi-drug resistant TB (MDR-TB) (OR, 3.8; 95 %CI, 1.4–10.4; P = 0.015). Additionally, acquired MDR-TB cases were more likely to emerge at later period around 3-5 months after treatment starting than that of non-MDR-TB mainly appeared within 2 months (OR, 8.3; 95 %CI, 1.7–39.9; P = 0.008). Treatment failure was associated with late acquired drug resistant TB emergence (OR, 25.7; 95 %CI, 4.3–153.4; P < 0.001) with the reference of early acquired drug resistant TB emergence.ConclusionsThis study demonstrates that later development of acquired drug resistant TB during SCC is liable to suffer treatment failure and acquired MDR-TB pattern may be one of the possible causes.

【 授权许可】

CC BY   
© Gao et al. 2016