Decline in rates of acquired multidrug-resistant tuberculosis after implementation of the directly observed therapy, short course (DOTS) and DOTS-Plus programmes in Taiwan.
J Antimicrob Chemother
; 68(8): 1910-6, 2013 Aug.
Article
em En
| MEDLINE
| ID: mdl-23580558
ABSTRACT
OBJECTIVES:
To investigate the impact of the directly observed therapy, short course (DOTS) and DOTS-Plus strategies on changes in resistance profiles among Mycobacterium tuberculosis (MTB).METHODS:
We performed a retrospective analysis of resistance profiles among isolates of MTB obtained from 2160 consecutive patients with culture-confirmed pulmonary tuberculosis (TB) between 2005 and 2011 at a referral centre in southern Taiwan.RESULTS:
Of the 2160 patients, 70 (3.2%) had primary multidrug-resistant (MDR)-TB, 178 (8.2%) had acquired MDR-TB, 10 (0.5%) had primary extensively drug-resistant (XDR)-TB, 23 (1.1%) had acquired XDR-TB and 5 (0.2%) had totally drug-resistant (TDR)-TB. Trend analysis revealed that the rates of acquired MDR-TB were significantly lower after implementation of the DOTS and DOTS-Plus programmes (Pâ<â0.01). There was a significant negative correlation between the coverage rates of the DOTS and DOTS-Plus programmes and the rates of acquired MDR-TB (râ=â-0.84, Pâ=â0.02 and râ=â-0.92, Pâ=â0.03, respectively). The rates of resistance to rifampicin, isoniazid, ofloxacin, moxifloxacin, levofloxacin and para-aminosalicylic acid also decreased significantly during the study period. However, the rates of primary MDR-TB remained stable (Pâ=â0.11). Multivariate logistic regression analysis showed that age ranging from 45 to 64 years, positive acid-fast stain results at the initiation of treatment and treatment without DOTS were independent risk factors associated with acquired MDR-TB. In addition, previous treatment for TB (100% versus 19% for TDR-TB and non-TDR-TB, Pâ<â0.01) and treatment without DOTS (80% versus 44% for TDR-TB and non-TDR-TB, Pâ=â0.18) were risk factors for TDR-TB.CONCLUSIONS:
DOTS and DOTS-Plus are both effective at preventing the acquisition of MDR-TB in Taiwan.Palavras-chave
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Base de dados:
MEDLINE
Assunto principal:
Tuberculose Resistente a Múltiplos Medicamentos
/
Transmissão de Doença Infecciosa
/
Terapia Diretamente Observada
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Antituberculosos
Idioma:
En
Ano de publicação:
2013
Tipo de documento:
Article