Outcomes after Chemotherapy with WHO Category II Regimen in a Population with High Prevalence of Drug Resistant Tuberculosis 英文参考文献.docVIP

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Outcomes after Chemotherapy with WHO Category II Regimen in a Population with High Prevalence of Drug Resistant Tuberculosis 英文参考文献.doc

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Outcomes after Chemotherapy with WHO Category II Regimen in a Population with High Prevalence of Drug Resistant Tuberculosis 英文参考文献

OutcomesafterChemotherapywithWHOCategoryII RegimeninaPopulationwithHighPrevalenceofDrug ResistantTuberculosis FrancineMatthys1*,LeenRigouts2,VincianeSizaire3,NataliaVezhnina4,MaryvonneLecoq3 ,Vera Golubeva5,Franc?oisePortaels2,PatrickVanderStuyft1,MichaelKimerling6¤ 1EpidemiologicalandDiseaseControlUnit,DepartmentofPublicHealth,InstituteofTropicalMedicine,Antwerp,Belgium,2MycobacteriologyUnit,InstituteofTropical Medicine,Antwerp,Belgium,3Me′decinssansFrontie`res,Brussels,Belgium,4HIV/TBPenalSystemProjectsinCentralAsianRepublics,AIDSFoundationEast-West,Alma Ata,Kazakhstan,5LaboratoryofMycobacteriology,Colony33,Mariinsk,Kemorovo,Russia,6UniversityofAlabamaatBirmingham,Birmingham,Alabama,UnitedStates ofAmerica Abstract StandardshortcoursechemotherapyisrecommendedbytheWorldHealthOrganizationtocontroltuberculosisworldwide. However, in settings with high drug resistance, first line standard regimens are linked with high treatment failure. We evaluated treatment outcomes after standardized chemotherapy with the WHO recommended category II retreatment regimeninaprisonwithahighprevalenceofdrugresistanttuberculosis(TB).Acohortof233culturepositiveTBpatients was followed through smear microscopy, culture, drug susceptibility testing and DNA fingerprinting at baseline, after 3 monthsandattheendoftreatment.Overall172patients(74%)becameculturenegative,while43(18%)remainedpositive attheendoftreatment.Amongthose43cases,58%offailuresweredeterminedtobeduetotreatmentwithaninadequate drugregimenand42%toeitheraninitialmixedinfectionorre-infectionwhileundertreatment.Overall,drugresistance amplification during treatment occurred in 3.4% of the patient cohort. This study demonstrates that treatment failure is linked to initial drug resistance, that amplification of drug resistance occurs, and that mixed infection and re-infection duringstandardtreatmentcontributetotreatmentfailureinconfinedsettingswithhighprevalenceofdrugresistance. Citation:MatthysF,RigoutsL,SizaireV,VezhninaN,LecoqM,eta