2002-2007年全球结核菌耐药性的流行病学

David

THE LANCET
Volume 373, Issue 9678, 30 May 2009-5 June 2009, Pages 1861-1873
Articles
Epidemiology of antituberculosis drug resistance 2002–07: an updated analysis of the Global Project on Anti-Tuberculosis Drug Resistance Surveillance
2002-2007年全球结核菌耐药性的流行病学
Dr Abigail Wright MPHa, , , Matteo Zignol MDa, Armand Van Deun MDb, c, Dennis Falzon MDd, Sabine Ruesch Gerdes PhDe, Prof Knut Feldman MDf, Sven Hoffner PhDg, Prof Francis Drobniewski MDh, Lucia Barrera MDi, Dick van Soolingen PhDj, Prof Fadila Boulabhal PhDk, CN Paramasivan PhDl, Kai Man Kam MDm, Satoshi Mitarai MDn, Paul Nunn MDa, Mario Raviglione MDa and for the Global Project on Anti-Tuberculosis Drug Resistance Surveillance‡

aStop TB Department, WHO, Geneva, Switzerland

bInternational Union Against Tuberculosis and Lung Disease, Paris, France

cMicrobiology Department, Mycobacteriology Unit, Institute of Tropical Medicine, Antwerp, Belgium

dEuroTB, Institut de Veille Sanitaire, Saint-Maurice, France

eNational Reference Center for Mycobacteria, Borstel, Germany

fInstitute of Microbiology and Laboratory Medicine, Asklepios Fachkliniken-Munich-Gauting, Germany

gSwedish Institute for Infectious Disease Control, Stockholm, Sweden

hHealth Protection Agency, National Mycobacterium Reference Unit, Department of Infectious Diseases, London, UK

iMycobacteria Laboratory, National Institute of Infectious Diseases, Buenos Aires, Argentina

jNational Institute of Public Health and the Environment (RIVM), Bilthoven, Netherlands

kLaboratoire de la Tuberculose, Institut Pasteur d'Algérie, Alger, Algeria

lTB Research Centre, Indian Council of Medical Research, Chennai, India

mTB Reference Laboratory Department of Health, Hong Kong SAR, China

nResearch Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan


Available online 15 April 2009.



Summary
Background
The Global Project on Anti-Tuberculosis Drug Resistance has been gathering data since 1994. This study provides the latest data on the extent of drug resistance worldwide.

Methods
Data for drug susceptibility were gathered from 90 726 patients in 83 countries and territories between 2002 and 2007. Standardised collection of results enabled comparison both between and within countries. Where possible, data for HIV status and resistance to second-line drugs were also obtained. Laboratory data were quality assured by the Supranational Tuberculosis Reference Laboratory Network.

Findings
The median prevalence of resistance to any drug in new cases of tuberculosis was 11·1% (IQR 7·0–22·3). The prevalence of multidrug resistance in new tuberculosis cases ranged from 0% in eight countries to 7% in two provinces in China, 11·1% in Northern Mariana Islands (although reporting only two cases), and between 6·8% and 22·3% in nine countries of the former Soviet Union, including 19·4% in Moldova and 22·3% in Baku, Azerbaijan (median for countries surveyed 1·6%, IQR 0·6–3·9). Trend analysis showed that between 1994 and 2007, the prevalence of multidrug-resistant (MDR) tuberculosis in new cases increased substantially in South Korea and in Tomsk Oblast and Orel Oblast, Russia, but was stable in Estonia and Latvia. The prevalence of MDR tuberculosis in all tuberculosis cases decreased in Hong Kong and the USA. 37 countries and territories reported representative data on extensively drug-resistant (XDR) tuberculosis. Five countries, all from the former Soviet Union, reported 25 cases or more of XDR tuberculosis each, with prevalence among MDR-tuberculosis cases ranging between 6·6% and 23·7%.

Interpretation
MDR tuberculosis remains a threat to tuberculosis control in provinces in China and countries of the former Soviet Union. Data on drug resistance are unavailable in many countries, especially in Africa, emphasising the need to develop easier methods for surveillance of resistance in tuberculosis.

Funding
Global Project: United States Agency for International Development and Eli Lilly and Company. Drug resistance surveys: national tuberculosis programmes, the Government of the Netherlands, the Global Fund to Fight AIDS, Tuberculosis and Malaria, Japan International Cooperation Agency, and Kreditanstalt für Wiederaufbau.