泛耐药结核感染综述（柳叶刀感染分册）

David

                               
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Review Extensively drug-resistant tuberculosis
泛耐药结核感染综述

Mandeep Jassal MDa and Prof William R Bishai MDb,

                               
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,

                               
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aDepartment of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
bDepartment of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA


Available online 5 November 2008.


SummaryExtensively drug-resistant (XDR) tuberculosis is defined as disease caused by Mycobacterium tuberculosis with resistance to at least isoniazid and rifampicin, any fluoroquinolone, and at least one of three injectable second-line drugs (amikacin, capreomycin, or kanamycin). The definition has applicable clinical value and has allowed for more uniform surveillance in varied international settings. Recent surveillance data have indicated that the prevalence of tuberculosis drug resistance has risen to the highest rate ever recorded. The gold standard for drug-susceptibility testing has been the agar proportion method; however, this technique requires several weeks for results to be determined. More sensitive and specific diagnostic tests are still unavailable in resource-limited settings. Clinical manifestations, although variable in different settings and among different strains, have in general shown that XDR tuberculosis is associated with greater morbidity and mortality than non-XDR tuberculosis. The treatment of XDR tuberculosis should include agents to which the organism is susceptible, and should continue for a minimum of 18–24 months. However, treatment continues to be limited in tuberculosis-endemic countries largely because of weaknesses in national tuberculosis health-care models. The ultimate strategy to control drug-resistant tuberculosis is one that implements a comprehensive approach incorporating innovation from the political, social, economic, and scientific realms.

Article OutlineIntroduction Definition Epidemiology Mechanisms of resistance and fitness in XDR tuberculosis Diagnostics Clinical course of XDR tuberculosis Treatment Potential solutions and prevention Improve global tuberculosis control by enhancing the testing and care of HIV-infected populations Strengthen laboratory capacity and diagnostics Improve infection control Develop comprehensive tuberculosis programme management strategiesConclusions Search strategy and selection criteria References

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