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【medical-news】简易方法可减少非洲致命肺结核感

简易方法可减少非洲致命肺结核感染

论文作者:Gerald Friedland 期刊:《柳叶刀》

11月2日的爱思唯尔期刊《柳叶刀》(The Lancet)刊登了耶鲁大学医学院的一项研究,该研究显示,如果通过采取一系列简单易行的感染控制措施,世界各地医院就能降低一半的广泛耐药结核(XDR-TB)的感染。广泛耐药结核是除耐多药结核(MDR-TB)之外,对任何氟喹诺酮类药物以及三种二线注射药物(硫酸卷曲霉素、卡那霉素和阿米卡星)中至少一种具有抗性的结核病菌。

广泛耐药结核具有很强的传染性和致命性,结核病菌的传播取决于任何一个地方传染性患者的数量和密度以及存在受感染风险较大的人等因素。包括美国在内全球37个国家已经报道了发现广泛耐药结核。该病在南非尤为严重,已成为当地的流行病。

耶鲁大学医学院的研究小组对南非Tugela Ferry县的农村地区的XDR-TB的感染人群数据建立了计算机模型,准确地模拟出广泛耐药结核和其它结核病的传染趋势。结果预计到2012年底会有超过1300人会感染广泛耐药结核。

肺结核患者通常具有传染性,并可通过咳嗽、打喷嚏或只是交谈传播该病,因为这会促使结核细菌扩散到空气中。人只要吸入少量这些病菌,就可能受到感染。有时候如果这些细菌来自耐药结核患者,它们早已具有耐药性。形成耐多药结核或广泛耐药结核的第二个途径是患者自身的结核产生耐药性。值得一提的是,结核是艾滋病毒/艾滋病患者中最常见的感染之一。在广泛耐药结核是最常见的地方,与未感染艾滋病毒的人相比,艾滋病毒感染者由于免疫力减弱,面临感染广泛耐药结核的更大风险。

该研究的一位负责人认为最初在南非发现XDR-TB的时候就已经为世界敲响警钟了。而这份报告所做的是提供一些希望,即存在简单、低成本的措施用于帮助控制这种局面。研究认为问题关键在于改变结核病护理的环境。如果采取一系列行之有效的控制措施:包括使用口罩、减少住院时间、改善通风和快速耐药性测试就可以将2012年Tugela Ferry县以及世界其他各地类似的资源短缺的医院中的XDR-TB病例减少一半。(于乃森 编译)

(《柳叶刀》(The Lancet),doi:10.1016/S0140-6736(07)61636-5,Sanjay Basu, Gerald H Friedland)

来源,科学网:http://www.sciencenet.cn/htmlpaper/20071224111449869535.html?id=535 Prevention of nosocomial transmission of extensively drug-resistant tuberculosis in rural South African district hospitals: an epidemiological modelling study

Sanjay Basu MSca, b, f, , , Jason R Andrews MDb, f, Eric M Poolman MDa, Neel R Gandhi MDc, f, N Sarita Shah MDc, f, Anthony Moll MBChBe, f, Prof Prashini Moodley PhDd, f, Alison P Galvani PhDa and Prof Gerald H Friedland MDa, b, f
aDepartment of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT, USA
bAIDS Program, Yale University School of Medicine, New Haven, CT, USA
cDivisions of General Internal Medicine, Infectious Diseases and Epidemiology, Albert Einstein College of Medicine, Bronx, NY, USA
dNelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
eChurch of Scotland Hospital and Philanjalo, Tugela Ferry, KwaZulu-Natal, South Africa
fTugela Ferry Care and Research Collaboration

Summary
Background

Extensively drug-resistant (XDR) tuberculosis has spread among hospitalised patients in South Africa, but the epidemic-level effect of hospital-based infection control strategies remains unknown. We modelled the plausible effect of rapidly available infection control strategies on the overall course of the XDR tuberculosis epidemic in a rural area of South Africa.
Methods

We investigated the effect of administrative, environmental, and personal infection control measures on the epidemic trajectory of XDR tuberculosis in the rural community of Tugela Ferry. Assessments were done with a mathematical model incorporating over 2 years of longitudinal inpatient and community-based data. The model simulated inpatient airborne tuberculosis transmission, community tuberculosis transmission, and the effect of HIV and antiretroviral therapy.
Findings

If no new interventions are introduced, about 1300 cases of XDR tuberculosis are predicted to occur in the area of Tugela Ferry by the end of 2012, more than half of which are likely to be nosocomially transmitted. Mask use alone would avert fewer than 10% of cases in the overall epidemic, but could prevent a large proportion of cases of XDR tuberculosis in hospital staff. The combination of mask use with reduced hospitalisation time and a shift to outpatient therapy could prevent nearly a third of XDR tuberculosis cases. Supplementing this approach with improved ventilation, rapid drug resistance testing, HIV treatment, and tuberculosis isolation facilities could avert 48% of XDR tuberculosis cases (range 34–50%) by the end of 2012. However, involuntary detention could result in an unexpected rise in incidence due to restricted isolation capacity.

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作者:admin@医学,生命科学    2011-07-22 05:14
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