Drug-resistant tuberculosis: a persistent global health concern

IF 69.2 1区 生物学 Q1 MICROBIOLOGY
Maha Farhat, Helen Cox, Marwan Ghanem, Claudia M. Denkinger, Camilla Rodrigues, Mirna S. Abd El Aziz, Handaa Enkh-Amgalan, Debrah Vambe, Cesar Ugarte-Gil, Jennifer Furin, Madhukar Pai
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Abstract

Drug-resistant tuberculosis (TB) is estimated to cause 13% of all antimicrobial resistance-attributable deaths worldwide and is driven by both ongoing resistance acquisition and person-to-person transmission. Poor outcomes are exacerbated by late diagnosis and inadequate access to effective treatment. Advances in rapid molecular testing have recently improved the diagnosis of TB and drug resistance. Next-generation sequencing of Mycobacterium tuberculosis has increased our understanding of genetic resistance mechanisms and can now detect mutations associated with resistance phenotypes. All-oral, shorter drug regimens that can achieve high cure rates of drug-resistant TB within 6–9 months are now available and recommended but have yet to be scaled to global clinical use. Promising regimens for the prevention of drug-resistant TB among high-risk contacts are supported by early clinical trial data but final results are pending. A person-centred approach is crucial in managing drug-resistant TB to reduce the risk of poor treatment outcomes, side effects, stigma and mental health burden associated with the diagnosis. In this Review, we describe current surveillance of drug-resistant TB and the causes, risk factors and determinants of drug resistance as well as the stigma and mental health considerations associated with it. We discuss recent advances in diagnostics and drug-susceptibility testing and outline the progress in developing better treatment and preventive therapies. In this Review, Pai and colleagues examine the global landscape of drug-resistant tuberculosis, exploring its epidemiology, causes, risk factors, stigma and associated mental health burden as well as discussing the most recent developments in diagnostics, treatment and preventive regimens.

Abstract Image

Abstract Image

耐药性结核病:全球持续关注的健康问题
据估计,耐药性结核病(TB)造成的死亡人数占全球抗菌药耐药性致死人数的 13%,其驱动因素包括耐药性的持续获得和人际传播。晚期诊断和有效治疗的不足加剧了不良后果。最近,快速分子检测技术的进步改善了结核病和耐药性的诊断。结核分枝杆菌的下一代测序加深了我们对遗传抗药性机制的了解,现在可以检测到与抗药性表型相关的突变。全口服、较短疗程的药物治疗方案可在 6-9 个月内达到较高的耐药结核病治愈率,现已问世并得到推荐,但尚未推广到全球临床使用。早期临床试验数据支持在高危接触者中预防耐药结核病的有希望的治疗方案,但最终结果尚未出炉。以人为本的方法对于耐药结核病的管理至关重要,可降低治疗效果不佳、副作用、耻辱感以及与诊断相关的心理健康负担的风险。在本综述中,我们将介绍目前对耐药性结核病的监测情况,耐药性的原因、风险因素和决定因素,以及与之相关的耻辱感和心理健康问题。我们讨论了诊断和药物敏感性测试方面的最新进展,并概述了在开发更好的治疗和预防疗法方面取得的进展。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Nature Reviews Microbiology
Nature Reviews Microbiology 生物-微生物学
CiteScore
74.00
自引率
0.50%
发文量
149
审稿时长
6-12 weeks
期刊介绍: At Nature Reviews Microbiology, our goal is to become the leading source of reviews and commentaries for the scientific community we cater to. We are dedicated to publishing articles that are not only authoritative but also easily accessible, supplementing them with clear and concise figures, tables, and other visual aids. Our objective is to offer an unparalleled service to authors, referees, and readers, and we continuously strive to maximize the usefulness and impact of each article we publish. With a focus on Reviews, Perspectives, and Comments spanning the entire field of microbiology, our wide scope ensures that the work we feature reaches the widest possible audience.
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