论文部分内容阅读
背景:1992年纽约市医院耐两种或更多种药物的活动性结核病情况。目的:检查纽约市1992年结核发病高峰期间,经鉴定命名为公共卫生研究所(PHRI)W株的具有高度耐药且有17条IS6110印迹带的结核菌在全市的分布情况。同时还将此W株与其它纽约市常见菌株加以比较。设计:应用双盲回归法对保存的结核菌培养物进行限定性片段长度多态性(RFLP)DNA指纹分析。结果:1992年中,我们在21所医院的住院病人中共分离112株W印迹株和8个变株。几乎所有的分离株均对四种一线药物和卡那霉素(KAN)耐药。1992年此单一菌株至少占纽约市多种耐药(MDR)结核病的22％,远高于其它任何一株。几乎所有的W株病例均是AIDS患者。该菌群为纽约市耐药程度最高且迄今为止与其它地区比较所鉴定出的最大的具有IS6110指纹相似性的菌群。结论:由于推荐的四药化疗方案对此高度耐药的菌群不能有效杀灭,因此90年代初在纽约AIDS患者中发生因W株感染而引起的结核暴发流行。其它常见菌株并非呈现高度耐药,甚至于令人惊奇的是表现为全敏感。单一多种耐药菌株能够在AIDS和结核均常见的地区引起广泛的播散。
Background: The New York City Hospital, 1992, has active tuberculosis resistant to two or more drugs. PURPOSE: To examine the distribution of highly resistant and 17 IS6110 blots in the city identified as WRI at the Institute of Public Health (PHRI) during the 1992 peak tuberculosis episode in New York City. This W strain was also compared to other common New York City strains. DESIGN: Finite Fragment Length Polymorphism (RFLP) DNA Fingerprinting Analysis of Preserved Mycobacterium Tuberculosis Culture Using Double-Blind Regression. RESULTS: In mid-1992, we isolated 112 W-blots and 8 strains of inpatients in 21 hospitals. Almost all isolates are resistant to four first-line drugs and kanamycin (KAN). This single strain accounted for at least 22% of New York City’s multi-drug resistant (MDR) tuberculosis in 1992, much higher than any other strain. Almost all of the W strains are AIDS patients. The flora is the largest in New York City with the highest degree of resistance and so far compared with other areas identified by IS6110 fingerprinting flora. CONCLUSIONS: Because the recommended four-drug regimen does not effectively kill this highly resistant population, TB outbreaks in the early 90s occurred in WN-infected New York patients. Other common strains are not highly resistant, and even surprisingly, they are all-hypersensitive. A single multi-drug resistant strain can cause widespread dissemination in areas common to AIDS and tuberculosis.