Risk Factors for MDR and XDR-TB in a Tertiary Referral Hospital in India 英文参考文献.docVIP

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Risk Factors for MDR and XDR-TB in a Tertiary Referral Hospital in India 英文参考文献.doc

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Risk Factors for MDR and XDR-TB in a Tertiary Referral Hospital in India 英文参考文献

RiskFactorsforMDRandXDR-TBinaTertiaryReferral HospitalinIndia V.Balaji1,PeterDaley2*,AlokAzadAnand3,ThambuSudarsanam2,JoySarojiniMichael1,RaniDiana Sahni1,PoorviChordia2,IgeAbrahamGeorge2,KurienThomas2,AlkaGanesh2,K.R.John4,DilipMathai2 1DepartmentofMicrobiology,ChristianMedicalCollegeVellore,Vellore,TamilNadu,India,2DepartmentofMedicine,ChristianMedicalCollegeVellore,Vellore,Tamil Nadu,India,3TuftsUniversitySchoolofMedicine,Boston, Massachusetts,UnitedStatesofAmerica,4DepartmentofCommunityMedicine,ChristianMedicalCollege Vellore,Vellore,TamilNadu,India Abstract Background:IndiahasahighburdenofdrugresistantTB,althoughtherearefewdataonXDR-TB.AlthoughXDR-TBhas existedpreviouslyinIndia,thedefinitionhasnotbeenwidelyapplied,andsurveillanceusingsecondlinedrugsusceptibility testinghasnotbeenperformed.Ourobjectivewastoanalyzeclinicalanddemographicriskfactorsassociatedwithisolation ofMDRandXDRTBascomparedtosusceptiblecontrols,atatertiarycenter. Methodology/Findings:Retrospectivechartreviewbasedonpositiveculturesisolatedinahighvolumemycobacteriology laboratorybetween2002and2007.47XDR,30MDRand117susceptiblecontrolswereexamined.Drugresistantcaseswere lesslikelytobeextrapulmonary,andhadreceivedmoreprevioustreatmentregimens.SignificantriskfactorsforXDR-TB includedresidenceoutsidethelocalstate(OR7.43,3.07-18.0)andcarecostssubsidized(OR0.23,0.097-0.54)inbivariate analysisandprevioususeofafluoroquinoloneandinjectableagent(otherthanstreptomycin)(OR7.00,95%C.I.1.14-43.03) and an initial treatment regimen which did not follow national guidelines (OR 5.68, 1.24-25.96) in multivariate analysis. CavitationandHIVdidnotinfluencedrugresistance. Conclusions/Significance: There is significant selection bias in the sample available. Selection pressure from previous treatmentandaninadequateinitialregimenincreasesriskofdrugresistance.Localpatientsandthoserequiringfinancial subsidiesmaybeatlowerriskofXDR-TB. Citation: Balaji V, Daley P, Anand AA, Sudarsanam T, Michael JS, et al. (2010) Risk