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背景:土耳其伊斯坦布尔,胸腔病和胸外科Sreyyapasa 中心,1992年1月至1992年12月。目标:评估本中心的初始和获得性抗结核药物耐药的存在率。设计:对785名被转诊至本中心的肺结核病人(旧病例和新病例分别为260人和525 人)的耐药模式进行了评估。结果:总耐药率(对1种或1种以上药物)为35.5％,初始耐药26.6％(525例中140例),获得性耐药53.4％(260例中139例)。初始耐药以对链霉素者最多见(20.6％),其次为利福平(10.8％),异烟肼(5.1%),和乙胺丁醇(4.2％)。对1种药物有初始耐药者占16.4％,对2种药物者占7.7％,对3种者占1.2％,对4种者占1.3％。在获得性耐药者中对利福平者最多见(36.2％),其次为对链霉素(31.9％),和异烟肼(30%)。在获得性耐药者中,对1种药物的占18.7%,对2种的占19.3%,对3种的占9.6％,对4种的占5.8％。结论:土耳其初始耐药的高存在率很可能对抗结核治疗的成功率构成威胁,因此必须在我国开始把至少使用4种一线药物作为常规,并由于对链霉素的高耐药率,以乙胺丁醇代替链霉素。总之,在土耳其旧病例的治疗仍在向人们提出挑战,因而亟需建立全国结核病控制规程,以便战胜初始和获得性耐药高存在率的严重局面。
Background: Sreyyapasa Center for Chest Diseases and Thoracic Surgery, Istanbul, Turkey, January 1992-December 1992. Objectives: To assess the prevalence of initial and acquired anti-TB drug resistance in our center. Design: The pattern of resistance in 785 TB patients (260 and 525 new and old cases, respectively) referred to the Center was evaluated. RESULTS: The overall resistance rate (35.5% for one or more drugs) was 26.6% for initial resistance (140 of 525) and 53.4% of acquired resistance (139 of 260). Initial resistance was highest among streptomycins (20.6%), followed by rifampicin (10.8%), isoniazid (5.1%), and ethambutol (4.2%). 16.4% were initially drug resistant to one drug, 7.7% were two drugs, 1.2% were three and 1.3% were four. Among the acquired drug-resistant persons, the most frequent (37.2%) were rifampin, followed by streptomycin (31.9%) and isoniazid (30%). Of the acquired drug-resistant individuals, 18.7% were for one drug, 19.3% for two, 9.6% for three, and 5.8% for four. CONCLUSIONS: The high prevalence of initial drug resistance in Turkey is likely to pose a threat to the success rate of anti-tuberculosis treatment and it is therefore necessary to start using at least 4 first-line drugs in our country as a routine and due to the high rate of resistance to streptomycin, Amine butanol instead of streptomycin. In conclusion, the treatment of old cases in Turkey is still challenging people and there is an urgent need to establish a national tuberculosis control protocol to overcome the serious situation of high rates of initial and acquired drug resistance.