Predictors of Multidrug- and Extensively Drug-Resistant Tuberculosis in a High HIV Prevalence Community 英文参考文献.docVIP

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Predictors of Multidrug- and Extensively Drug-Resistant Tuberculosis in a High HIV Prevalence Community 英文参考文献.doc

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Predictors of Multidrug- and Extensively Drug-Resistant Tuberculosis in a High HIV Prevalence Community 英文参考文献

PredictorsofMultidrug-andExtensivelyDrug-Resistant TuberculosisinaHighHIVPrevalenceCommunity JasonR.Andrews1,N.SaritaShah2,DarrenWeissman3,AnthonyP.Moll4,GeraldFriedland5,NeelR. Gandhi6* 1DivisionofInfectiousDiseases,MassachusettsGeneralHospital,HarvardMedicalSchool,Boston,Massachusetts,UnitedStatesofAmerica,2DepartmentsofMedicine andEpidemiologyPublicHealth,AlbertEinsteinCollegeofMedicineandMontefioreMedicalCenter,NewYork,NewYork,UnitedStatesofAmerica,3Departmentof Medicine,AlbertEinsteinCollegeofMedicineandMontefioreMedicalCenter,NewYork,NewYork,UnitedStatesofAmerica,4PhilanjaloandChurchofScotlandHospital, Tugela Ferry, KwaZulu-Natal, South Africa, 5AIDS Program, Yale University School of Medicine, New Haven, Connecticut, United States of America, 6Departments of MedicineandEpidemiologyPublicHealth,AlbertEinsteinCollegeofMedicineandMontefioreMedicalCenter,NewYork,NewYork,UnitedStatesofAmerica Abstract Background:Multidrug-resistant(MDR)andextensivelydrug-resistant(XDR)tuberculosis(TB)haveemergedinhigh-HIV- prevalencesettings,whichgenerallylacklaboratoryinfrastructurefordiagnosingTBdrugresistance.Evenwhereavailable, inherent delays with current drug-susceptibility testing (DST) methods result in clinical deterioration and ongoing transmissionofMDRandXDR-TB.Identifyingclinicalpredictorsofdrugresistancemayaidinriskstratificationforearlier treatmentandinfectioncontrol. Methods:Weperformedaretrospectivecase-controlstudyofpatientswithMDR(cases),XDR(cases)anddrug-susceptible (controls) TB in a high-HIV-prevalence setting in South Africa to identify clinical and demographic risk factors for drug- resistantTB.Controlswereselectedina1:1:1ratioandwerenotmatched.Wecalculatedoddsratios(OR)andperformed multivariatelogisticregressiontoidentifyindependentpredictors. Results:Weenrolled116,123and139patientswithdrug-susceptible,MDR,andXDR-TB.Morethan85%inallthreepatient groups were HIV-infected. In multivariate analysis, MDR and XDR-TB were each strongly associated with history of