Clinical Experience with Multidrug-Resistant Tuberculosis in a TB Referral Hospital

結核後送地區醫院多重抗藥性肺結核之經驗

蔡宏津(Hung-Chin Tsai) ； 施正蓮(Cheng-Len Sy) ； 李欣蓉(Susan Shin-Jung Lee) ； 陳瑩霖(Eng-Rin Chen) ； 胡麗芳(Li-Fang Hu) ； 楊蓮芝(Lien-Chih Yang) ； 顏全敏(Chuan-Min Yen) ； 陳垚生(Yao-Shen Chen) ； 劉永慶(Yung-Ching Liu)

《南臺灣醫學雜誌》 3卷1期 (2007/06) Pp. 6-14

https://doi.org/10.6726/MJST.200706_3(1).0002

摘要

為了分析一地區醫院多重抗藥性肺結核病人之臨床表現及治療結果，自1999年十一月至2001年十月，我們分析結核菌實驗室之所有培養紀錄，同時分析多重抗藥性肺結核病人之臨床表現及治療結果，結核菌之培養是以MGIT 960系統來做初步鑑定之後用傳統之L-J medium 作確認，至於藥物感受性試驗是以商品化之plate，利用agar proportional方法來執行。在二年中，共分離410株結核菌（408個病人），其中抗藥性之比例分別為isoniazid 25%，rifampin 10.5%，ethambutol 9%，kanamycin 5.4%，ofloxacin 4.1%，總計多重抗藥性結核菌8.3%。罹患多重抗藥性肺結核之20個病人中，最常見之臨床症狀分別是咳嗽85%，喘息70%，痰多65%。最常見之檢驗異常分別為貧血45%，低白蛋白血症45%。每一病人平均接受之5種藥（1-7種），其中只有9個病人培養轉陰平均4.2個月的治療，治療成功率僅40%，且4個病人死亡。統計分析顯示與不良治療結果有關之因素為病人抗藥之數目及使用來治療之藥物數目。在台灣肺結核的抗藥性逐漸增加，如要好好控制及消滅肺結核，民眾及醫師之教育極為重要。

關鍵字

多重抗藥性肺結核

並列摘要

Objective: To analyze the outcome and clinical manifestations of patients with multidrug-resistant tuberculosis (MDR- TB) in a regional TB referral center.Methods: From November 1999 through October 2001, all isolates of Mycobacterium tuberculosis with drug resistance were identified via a retrospec-tive review of our mycobacteriolo-gical rereview of our mycobacteriolo-gical records. The medical records of patients with culture proven drug- resistant TB were retrospectively analyzed. MDR-TB was defined as resistance to at least isoniazid and rifampin in vitro. The identification of TB was performed using Mycobacteria growth indicator tube (MGIT) 960 system and drug sensitivity was done by the agar proportional method with a commercial plate.Results: From November 1999 through October 2001, a total of 410 isolates through October 2001, a total of 410 isolates of M. tuberculosis from 408 patients were cultured (408 sputum, 1 pus, 1 pleural effusion). The drug resistance rate of isoniazid was 2.5%, rifampin 10.5%, ethambutol 9%, kanamycin 5.4%, ofloxacin 4.1%, and MDR-TB was 8.3%. The charts of 20 patients with MDR-TB were reviewed. The most common clinical symptoms were cough (85%), dyspnea (70%) and sputum production (65%). The most frequent laboratory findings were most frequent laboratory findings were anemia (45%) and hypoalbuminemia (45%). A mean number of 5 drugs (range 1 to 7) were given for treatment during the course. Culture became negative in 9 patients after a mean of 4.2 months (treatment range 2 to 8). The overall success rate of treatment was 40%. Four patients died. Variables independently associated with an adverse outcomes included the number of drugs to which the TB isolate was resistant (2.9±0.8 v.s. 4.2±1.1, p=0.012) and the number of drugs used for chemotherapy (6.6±0.7 vs 3.4±1.9; p＜0.001). Drug resistant TB was not suspected at initial presentation in 50% of the patients and 3 patients were diagnosed postmortem.Conclusions: Most patients with MDR-TB in this regional referral hospital were inappropriately treated. When appropriate and intensive treatment regimens were used, most patients with MDR-TB can be cured. Hence, if control and eradication of TB is to be achieved, education of patients and doctors in the early recognition and treatment of MDR-TB in this high TB prevalent area is of utmost importance.

並列關鍵字

multi-drug resistant tuberculosis