Antituberculosis drug resistance acquired during treatment: an analysis of cases reported in California, 1994-2006.
Clin Infect Dis
; 56(6): 761-9, 2013 Mar.
Article
de En
| MEDLINE
| ID: mdl-23223590
ABSTRACT
BACKGROUND:
To inform efforts to prevent antituberculosis drug resistance acquired during treatment, particularly multidrug-resistant (MDR) tuberculosis, we analyzed surveillance records from the US state with the highest morbidity.METHODS:
Surveillance data from the California tuberculosis registry of cases reported between 1994 and 2006 were examined retrospectively. Crude risks of acquired resistance were estimated. Multivariate logistic regression was used to estimate odds ratios of demographic, clinical, and case management characteristics associated with acquired drug resistance (ADR), and secular trends in the incidence of ADR were assessed.RESULTS:
One in 688 patients acquired MDR tuberculosis, with crude risks varying greatly by initial drug susceptibility testresults:
1 in 1909 if initially susceptible to isoniazid and rifampin, 1 in 113 if initially isoniazid resistant, and 1 in 23 if initially rifampicin resistant. Acquired isoniazid and rifampicin monoresistance occurred in 1 in 1018 and 1 in 1455 patients, respectively. Independent predictors of acquired MDR tuberculosis were initial isoniazid resistance (odds ratio [OR], 19.2; 95% confidence interval [CI], 8.25-44.7; P < .001), initial rifampicin resistance (OR, 35.9; 95% CI, 8.61-150; P < .001), human immunodeficiency virus (HIV) infection (OR, 5.07; 95% CI, 1.73-14.9; P = .003), and cavitary disease in the absence of directly observed therapy throughout therapy (OR, 2.65; 95% CI, 1.05-6.69; P = .04). The annual incidence of ADR declined over the study period.CONCLUSIONS:
Although ADR is rare and declining in California, its costly consequences warrant improvements in treatment practices. Our findings suggest that we ensure DOT throughout the course of therapy for patients with baseline drug resistance, cavitary disease, or HIV infection.
Texte intégral:
1
Collection:
01-internacional
Base de données:
MEDLINE
Sujet principal:
Tuberculose pulmonaire
/
Résistance bactérienne aux médicaments
/
Mycobacterium tuberculosis
/
Antituberculeux
Type d'étude:
Incidence_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limites:
Adult
/
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Pays/Région comme sujet:
America do norte
Langue:
En
Journal:
Clin Infect Dis
Sujet du journal:
DOENCAS TRANSMISSIVEIS
Année:
2013
Type de document:
Article
Pays d'affiliation:
États-Unis d'Amérique