PDF(Pubmed)
Abstract：
Multidrug-resistant tuberculosis (TB) (MDR-TB), or TB that is simultaneously resistant to both isoniazid (INH) and rifampicin (RIF), is a barrier to successful TB control and treatment. Stratified data on MDR-TB, particularly in the high-burden western Kenya region, remain unknown. This data is important to monitor the efficacy of TB control and treatment efforts. Herein, we determined the molecular epidemiology of drug-resistant TB and associated risk factors in western Kenya. This was a non-experimental, population-based, cross-sectional study conducted between January and August 2018. Morning sputum samples of individuals suspected of pulmonary TB were collected, processed, and screened for Mycobacterium tuberculosis (Mtb) and drug resistance using line probe assay (LPA) and Mycobacterium growth indicator tubes (MGIT) culture. MGIT-positive samples were cultured on brain heart infusion (BHII) agar media, and the presence of Mtb was validated using Immunochromatographic assay (ICA). Drug sensitivity was performed on MGIT and ICA-positive but BHI-negative samples. Statistical significance was set at P < 0.05. Of the 622 Mtb isolates, 536 (86.2%) were susceptible to RIF and INH. The rest, 86 (13.83%), were resistant to either drugs or both. A two-sample proportional equality test revealed that the MDR-TB prevalence in western Kenya (5%) did not vary significantly from the global MDR-TB estimate (3.9%) (P = 0.196). Men comprised the majority of susceptible and resistant TB (75.9% and 77.4%%, respectively). Also, compared with healthy individuals, the prevalence of HIV was significantly higher in MDR-TB patients (35.9% vs 5.6%). Finally, TB prevalence was highest in individuals aged 25-44 years, who accounted for 58.4% of the total TB cases. Evidently, the prevalence of MDRTB in western Kenya is high. Particular attention should be paid to men, young adults, and those with HIV, who bear the greatest burden of resistant TB. Overall, there is a need to refine TB control and treatment programs in the region to yield better outcomes.
摘要：
耐多药结核病（TB）（MDR-TB），或同时对异烟肼（INH）和利福平（RIF）具有抗性的TB，是成功控制和治疗结核病的障碍。耐多药结核病分层数据，特别是在高负担的肯尼亚西部地区，仍然未知。这些数据对于监测结核病控制和治疗努力的有效性非常重要。在这里，我们确定了肯尼亚西部耐药结核病的分子流行病学和相关危险因素.这是非实验性的,以人口为基础,2018年1月至8月进行的横断面研究.收集疑似肺结核患者的早晨痰标本,已处理,并使用线探针测定（LPA）和分枝杆菌生长指示管（MGIT）培养物筛选结核分枝杆菌（Mtb）和耐药性。MGIT阳性样品在脑心输注（BHII）琼脂培养基上培养，Mtb的存在使用免疫层析(ICA)进行验证。对MGIT和ICA阳性但BHI阴性的样品进行药物敏感性。P<0.05时具有统计学意义。在622个Mtb分离株中，536例（86.2%）易感RIF和INH。其余的,86（13.83%），对两种药物都有抗药性。两样本比例平等检验显示，肯尼亚西部的耐多药结核病患病率（5％）与全球耐多药结核病估计值（3.9％）没有显着差异（P=0.196）。男性占大多数易感和耐药结核病（75.9％和77.4％，分别)。此外，与健康个体相比，MDR-TB患者中HIV的患病率显著较高(35.9%vs5.6%).最后,结核病患病率在25-44岁的人群中最高，占总结核病例的58.4%。显然,肯尼亚西部MDRTB的患病率很高。应该特别注意男人，年轻人,那些感染艾滋病毒的人，他们承受着最大的耐药结核病负担。总的来说,有必要完善该地区的结核病控制和治疗计划,以取得更好的结果.
