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Dtsch Med Wochenschr 2008; 133(8): 374-376
DOI: 10.1055/s-2008-1046724
Kommentar | Commentary
Infektiologie
© Georg Thieme Verlag KG Stuttgart · New York

Extensiv-resistente Tuberkulose (XDR-TB)

Extensively drug-resistant tuberculosisC. Lange1 , M. P. Grobusch2 , D. Wagner3
  • 1 Klinische Infektiologie, Medizinische Klinik, Forschungszentrum Borstel
  • 2 Infectious Diseases Unit, Division of Clinical Microbiology and Infectious Diseases, National Health Laboratory Services and School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Südafrika
  • 3 Zentrum für Infektiologie und Reisemedizin, Medizinische Klinik, Universität Freiburg
Further Information

Publication History

eingereicht: 19.11.2007

akzeptiert: 10.1.2008

Publication Date:
13 February 2008 (online)

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Zusammenfassung

In den vergangenen Jahren werden weltweit zunehmende Antibiotika-Resistenzen von Mycobacterium tuberculosis (MTB) Stämmen beschrieben. Der Begriff XDR (extensively drug-resistant)-Tuberkulose wurde von der Weltgesundheitsorganisation (WHO) eingeführt, um multiresistente MTB-Stämme mit weiteren Antibiotika-Resistenzen gegenüber Fluorochinolonen und einem der injizierbaren Substanzen Amikacin, Capreomycin oder Kanamycin neben Isoniazid- und Rifampicin-Resistenzen zu charakterisieren. XDR-MTB-Stämme breiten sich aktuell im südlichen Afrika durch Kontakte vor allem unter HIV-seropositiven Personen stark aus. Hier stellt die XDR-TB-Epidemie für das Gesundheitswesen eine schwer lösbare Aufgabe dar. In Deutschland werden vereinzelt XDR-TB-Fälle, vor allem unter vortherapierten Migranten aus osteuropäischen Staaten, beobachtet. Die Entwicklung schneller diagnostischer Methoden zur Resistenztestung und neuer Präparate zur Therapie der Tuberkulose wurde in den vergangenen Jahrzehnten unzureichend unterstützt. Durch die plötzliche Zunahme von XDR-MTB-Stämmen besteht nun hohe Dringlichkeit zur Entwicklung solcher Testverfahren und neuer Substanzklassen, um allen Patienten eine Chance für eine effektive Behandlung der Tuberkulose zu ermöglichen.

Abstract: Extensively drug-resistant tuberculosis

Recently an increasing number of antibiotic-resistant Mycobacterium tuberculosis (MTB) strains have been described worldwide. The term XDR- (extensively drug-resistant) tuberculosis (TB) has been introduced by the World Health Organisation (WHO) to characterize multi-drug-resistant MTB strains that are in vitro resistant against fluorochinolones and one of the injectible substances amikacin, capreomycin or kanamycin in addition to isoniazid and rifampin. Strains of XDR-MTB are currently increasingly seen in HIV-seropositive individuals with tuberculosis in southern Africa, where these strains are passed by person-to person contact. XDR-TB has become a serious problem for the health administrations in this region. In contrast, cases of XDR-TB are only rarely seen in Germany so far, mainly among the population of pre-treated migrants from eastern Europe. The development of rapid diagnostic tests for resistance testing and new drugs for the treatment of tuberculosis has lacked support for several decades. The sudden emergence of XDR-MTB strains now warrants immediate action for the development of such tests and new classes of antibiotics to give all patients with TB a chance for a successful treatment.

Schlüsselwörter

Tuberkulose - XDR-Tuberkulose - Resistenz

Key words

tuberculosis - XDR tuberculosis - extensively drug-resistant tuberculosis

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PD Dr. med. Dirk Wagner

Abteilung Innere Medizin, Zentrum für Infektiologie und Reisemedizin der Universität Freiburg

Hugstetter Str. 55

79106 Freiburg

Phone: 0761/270-1819

Fax: 0761/270-1820

Email: Dirk.Wagner@uniklinik-freiburg.de