{"id":478,"date":"2016-08-08T16:17:19","date_gmt":"2016-08-08T13:17:19","guid":{"rendered":"http:\/\/infeksiyon.org\/?p=478"},"modified":"2016-08-08T16:17:19","modified_gmt":"2016-08-08T13:17:19","slug":"birlesik-devletlerde-pirazinamide-direncli-tuberkuloz-epidemiyolojisi","status":"publish","type":"post","link":"https:\/\/infeksiyon.org\/en\/birlesik-devletlerde-pirazinamide-direncli-tuberkuloz-epidemiyolojisi\/","title":{"rendered":"Epidemiology of Pyrazinamide-Resistant Tuberculosis in the United States, 1999\u20132009"},"content":{"rendered":"<p style=\"text-align: justify;\"><strong><em>Background.<\/em><\/strong>Pyrazinamide (PZA) is essential in tuberculosis treatment. We describe the prevalence, trends, and predictors of PZA resistance in\u2003<em>Mycobacterium tuberculosis<\/em>\u00a0complex (MTBC) in the United States.<\/p>\n<p style=\"text-align: justify;\"><strong><em>Methods.<\/em><\/strong>We analyzed culture-positive MTBC cases with reported drug susceptibility tests for PZA in 38 jurisdictions routinely testing for PZA susceptibility from 1999 to 2009. National Tuberculosis Genotyping Service data for 2004\u20132009 were used to distinguish\u2003\u00a0<em>M. tuberculosis<\/em>\u00a0from<em>Mycobacterium bovis<\/em>\u00a0and determine phylogenetic lineage.<\/p>\n<p style=\"text-align: justify;\"><strong><em>Results.<\/em><\/strong>Overall 2.7% (2167\/79 321) of MTBC cases had PZA resistance, increasing annually from 2.0% to 3.3% during 1999\u20132009 (\u2003<em>P<\/em>\u00a0&lt; .001), largely because of an increase in PZA monoresistance. PZA-monoresistant MTBC (vs drug-susceptible) was associated with an age of 0\u201324 years (adjusted prevalence ratio [aPR],1.50; 95% confidence interval [CI], 1.31\u20131.71), Hispanic ethnicity (aPR, 3.52; 95% CI, 2.96\u20134.18), human immunodeficiency virus infection (aPR, 1.43; 95% CI, 1.15\u20131.77), extrapulmonary disease (aPR, 3.02; 95% CI, 2.60\u20133.52), and normal chest radiograph (aPR, 1.88; 95% CI, 1.63\u20132.16) and was inversely associated with Asian (aPR, 0.59; 95% CI, .47\u2013.73) and black (aPR, 0.37; 95% CI, .29\u2013.49) race. Among multidrug-resistant (MDR) cases, 38.0% were PZA-resistant; PZA resistance in MDR MTBC was associated with female sex (aPR, 1.25; 95% CI, 1.08\u20131.46) and previous tuberculosis diagnosis (aPR, 1.37; 95% CI, 1.16\u20131.62). Of 28 080 cases with genotyping data, 925 (3.3%) had PZA resistance; 465 of 925 (50.3%) were\u00a0<em>M. bovis<\/em>. In non-MDR<em>M. tuberculosis<\/em>\u00a0cases, PZA resistance was higher in the Indo-Oceanic than the East Asian lineage (2.2% vs 0.9%, respectively; aPR, 2.26; 95% CI, 1.53\u20133.36), but in MDR cases it was lower in the Indo-Oceanic lineage (22.0% vs 43.4%, respectively; aPR, 0.54; 95% CI, .32\u2013.90).<\/p>\n<p style=\"text-align: justify;\"><strong><em>Conclusions.<\/em><\/strong>Specific human and mycobacterial characteristics were associated with PZA-resistant MTBC, reflecting both specific subgroups of the population and phylogenetic lineages of the mycobacteria.<\/p>\n<p style=\"text-align: justify;\">\n<p style=\"text-align: justify;\"><a href=\"http:\/\/cid.oxfordjournals.org\/content\/current\">http:\/\/cid.oxfordjournals.org\/content\/current<\/a><\/p>\n<p style=\"text-align: justify;\">\u00a0<strong>HABER: Dr. Sibel Boluk\u00e7u<\/strong><\/p>\n<p style=\"text-align: justify;\"><strong>Posted Oct\u0131ber 03, 2013<\/strong><\/p>","protected":false},"excerpt":{"rendered":"<p>Background.Pyrazinamide (PZA) is essential in tuberculosis treatment. We describe the prevalence, trends, and predictors of PZA resistance in\u2003Mycobacterium tuberculosis\u00a0complex (MTBC) in the United States. Methods.We analyzed culture-positive MTBC cases with reported drug susceptibility tests for PZA in 38 jurisdictions routinely testing for PZA susceptibility from 1999 to 2009. National Tuberculosis Genotyping Service data for 2004\u20132009&#8230; <\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_links_to":"","_links_to_target":""},"categories":[9],"tags":[],"_links":{"self":[{"href":"https:\/\/infeksiyon.org\/en\/wp-json\/wp\/v2\/posts\/478"}],"collection":[{"href":"https:\/\/infeksiyon.org\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/infeksiyon.org\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/infeksiyon.org\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/infeksiyon.org\/en\/wp-json\/wp\/v2\/comments?post=478"}],"version-history":[{"count":1,"href":"https:\/\/infeksiyon.org\/en\/wp-json\/wp\/v2\/posts\/478\/revisions"}],"predecessor-version":[{"id":479,"href":"https:\/\/infeksiyon.org\/en\/wp-json\/wp\/v2\/posts\/478\/revisions\/479"}],"wp:attachment":[{"href":"https:\/\/infeksiyon.org\/en\/wp-json\/wp\/v2\/media?parent=478"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/infeksiyon.org\/en\/wp-json\/wp\/v2\/categories?post=478"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/infeksiyon.org\/en\/wp-json\/wp\/v2\/tags?post=478"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}