Двенадцать наиболее частых вопросов о нетуберкулезных микобактериях

Статья в Elpub

Рецепт. 2019; : 244-258

Двенадцать наиболее частых вопросов о нетуберкулезных микобактериях

Рузанов Д. Ю., Давидовская Е. И., Буйневич И. В., Дубровский А. С., Бондаренко В. Н., Яцкевич Н. В.

Аннотация

Большинство эпидемиологических исследований в мире отмечают в последние 10 лет существенный рост заболеваний, вызванных нетуберкулезными микобактериями. Наиболее часто упоминаемые причины роста: внедрение современных методов обнаружения нетуберкулезных микобактерий и хорошая осведомленность врачей в отношении диагноза. Основой лечения микобактериоза является поликомпонентная химиотерапия. Несмотря на многочисленные исследования и достижения в области лечения микобактериозов, эффективность терапии остается не высокой, что обусловлено, с одной стороны, видовой резистентностью микобактерий к антибактериальным лекарственным средствам, с другой стороны, необходимостью длительного лечения с высокой вероятностью нежелательных лекарственных реакций, что приводит к отрывам от лечения и развитию устойчивости микобактерий, что, как следствие, снижает вероятность эффективности текущего или последующего курса терапии. В статье приведены современные подходы к диагностике и лечению заболеваний, вызванных нетуберкулезными микобактериями, на основании анализа статей и руководств, доступных в электронных медицинских ресурсах NCBI, PMC, Google Scholar, PubMed, Scopus, eLIBRARY с позиции доказательной медицины. Приведены алгоритмы Американского торакального общества, дополненные руководствами Британского торакального общества (2017), масштабными рандомизированными исследованиями (2015-2019) в отношении медленнорастущего комплекса М. avium,M. kansasii, M. malmoense, M. xenopi и комплекса M. abscessus. Статья построена в виде ответов на наиболее частые вопросы, с которыми сталкиваются авторы в повседневной клинической практике. Кроме алгоритма диагностики, выбора схемы лечения и роли тестов лекарственной чувствительности освещаются вопросы диспансеризации, инфекционного контроля, вспомогательных и хирургических методов лечения заболеваний, вызванных нетуберкулезными микобактериями.

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Recipe. 2019; : 244-258

Twelve Most Common Questions about Non-Tuberculous Mycobacteria

Ruzanov D. ., Davidovskaya E. ., Buynevich I. ., Dubrovsky A. ., Bondarenko V. ., Yatskevich N. .

Abstract

The majority of epidemiological studies in the world have noted a significant increase in diseases caused by non-tuberculous mycobacteria in the past 10 years. The most frequently mentioned reasons for growth are the introduction of modern methods for detecting non-tuberculous mycobacteria and a good awareness of doctors regarding diagnosis. Mycobacteriosis is based on multicomponent chemotherapy. Despite numerous studies and advances in the treatment of mycobacteriosis, the effectiveness of therapy remains low, which is due on the one hand to mycobacterial species resistance to antibacterial drugs, on the other hand the need for long-term treatment with a high probability of undesirable drug reactions leading to disconnections from treatment and to the development of resistance of mycobacteria and, as a result, reduces the likelihood of the effectiveness of current or subsequent therapy. The article presents modern approaches to the diagnosis and treatment of diseases caused by non-tuberculous mycobacteria based on the analysis of articles and guidelines available in the electronic medical resources of NCBI, PMC Google Scholar PubMed, Scopus, eLIBRARY from the standpoint of evidence-based medicine. The algorithms of the American Thoracic Society are supplemented by the guidelines of the British Thoracic societies (2017), large-scale randomized studies (2015-2019) in relation to the slowly growing complex M. avium, M. kansasii, M. malmoense, M. xenopi, and the complexM. abscessus. The article is constructed in the form of answers to the most frequent questions faced by the authors in everyday clinical practice. In addition to the diagnostic algorithm, the choice of treatment regimen and the role of drug sensitivity tests, the issues of infection control, auxiliary and surgical methods of treatment of diseases caused by non-tuberculous mycobacteria are covered.

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