廣泛抗藥性結核病

Extensively Drug Resistant Tuberculosis (XDR-TB)

在2021年，世界衛生組織定義廣泛抗藥性結核病(extensively drug resistant tuberculosis, XDR-TB)為同時符合三個條件：(1)對isoniazid及rifampicin有抗藥性；(2)對任何一種fluoroquinolone有抗藥性；(3)對bedaquiline或linezolid有抗藥性。導致廣泛抗藥性結核病(XDR-TB)盛行的原因主要有：(1)在治療期間原來不具抗藥性的菌株，轉變成抗藥性菌株（獲得抗藥性）；(2)由於不適當的藥物治療，導致抗藥性菌株的發展(增強抗藥性)；(3)獲得抗藥性基因的案例(傳遞型抗藥性)。臺灣的抗藥性監測資料在2006年底以前是來自於各醫院的研究資料收集得知，其中多重抗藥性結核病(MDR-TB)的比率從0.2%(1984-1990)一直逐年往上升至2%(1997-2000)。為有效控制多重抗藥性結核病(MDR-TB)疫情，避免演化成廣泛抗藥性結核病(XDR-TB)的危機，從2006年起臺灣建立MDR-TB(multi-drug resistant tuberculosis)通報系統，到現今所推動進階都治計畫(DOTS-Plus)以及時監控所有多重抗藥性結核病(MDR-TB)的病患，避免衍生出更多廣泛抗藥性結核病(XDR-TB)之病患。

In 2021, the World Health Organization defines XDR-TB (Extensively Drug Resistant Tuberculosis) as resistant to (1) isoniazid and rifampicin, (2) any type of fluoroquinolone, and (3) bedaquiline or linezolid. The reasons to cause XDR-TB to disseminate are illustrated below. (1) Strains without drug resistance become drug-resistant during treatment (gain drug resistance), (2) Inappropriate medical treatment causes drug-resistant strains to develop (enhance drug resistance), and (3) gain drug resistance from cases with resistant strains. The anti-microbial resistance monitoring data was collected from hospitals’ research by the end of 2006, with the morbidity rate increasing annually from 0.2% (1984-1990) to 2% (1997-2000). To effectively control the MDR-TB epidemic and prevent it from becoming the crisis of XDR-TB, Taiwan, since 2006, has established a multi-drug resistant tuberculosis reporting system and a DOTS-Plus plan to timely monitor MDR-TB patients and prevent them from deteriorating into XDR-TB.