2006-2017年天津市结核分枝杆菌耐药性分析
|
摘要
目的回顾性分析12年间天津市结核分枝杆菌对4种一线抗结核药物和部分二线抗结核药物的耐药性,为结核病的诊治工作提供参考。方法选择2006年1月-2017年12月于医院就诊的结核病患者77 739例分离的结核分枝杆菌共20 212株,追踪其4种一线抗结核药物[异烟肼(H)、利福平(R)、乙胺丁醇(E)、链霉素(S)]及部分二线抗结核药物[氨基水杨酸(PAS)、丁胺卡那霉素(AK)、左氧氟沙星(V)、氧氟沙星(O)、卷曲霉素(Cm)、卡那霉素(Km)、环丙沙星、丙硫异烟胺(Pto)]的耐药结果,并分析其耐药性变化。结果 2006-2017年共检出结核分枝杆菌20 212株,单耐药、多耐药、耐多药分别占13.68%(2 765/20 212)、8.80%(1 778/20 212)、12.29%(2 484/20 212)。2013-2017年泛耐药共计74株,占同期总菌株数的0.53%(74/14 092)。2006-2017各年间总体耐药率在31.00%～40.89%;12年间快培阳性结核分枝杆菌15 118株,耐单药次序为H>S>R>E;2013-2017年5年间慢培阳性结核分枝杆菌5 094株,耐药顺序为S>H>R>E>PAS,氧氟沙星耐药菌株占同期总菌株数的15.92%(690/4 334),卷曲霉素1.76%(73/4 155)。结论 12年间总耐药率呈逐渐下降趋势,但近两年有所回升;耐多药率偏高,广泛耐药率控制在较低水平。12年间结核分枝杆菌对S、H、R、E四种一线抗结核药物耐药率在2008年达到最低点,近三年较前有所回升。
OBJECTIVE To retrospectively analyze the resistance of Mycobacterium tuberculosis to 4 kinds of firstline and some kinds of second-line anti-TB drugs during 2006-2017 in Tianjin,and to provide scientific reference for diagnosis and treatment of tuberculosis.METHODS A total of 20 212 strains isolated from 77739 tuberculosis patients treated in the hospital during Jan.2006 to Dec.2017 were selected,then the drug susceptibility test results for 4 kinds of first-line[isoniazid(H),rifampicin(R),ethambutol(E),streptomycin(S)]and some kinds of second-line anti-TB drugs [including aminosalicylate(PAS),amikacin(AK),levofloxacin(V),ofloxacin(O),capreomycin(Cm),kanamycin(Km),ciprofloxacin and protionamid(Pto)]were traced,and the change in drug resistance was analyzed.RESULTS A total of 20 212 strains of M tuberculosis were detected from 2006-2017,the mono-resistant rate,poly-resistant rate and multidrug-resistant rate were 13.68%,8.80%and 12.29%,respectively.There were 74 strains of extensively drug-resistant M tuberculosis strains from 2013 to 2017,accounting for 1.50% of the total strains in the same period.The total drug-resistance rate from 2006 to 2017 was between 31.00% and 40.89%.There were 15118 strains cultured positive by using BACTEC MGIT960-TB liquid culture method from 2006 to 2017,and the order of drug resistance was H>S>R>E.There were 5 094 strains cultured positive by using modified Roche medium culture method from 2013 to 2017,and the order of drug resistance was S>H>R>E>PAS.The resistance rate to ofloxacin and capreomycin was 15.92%(690/4 334)and1.76%(73/4 155)respectively.CONCLUSIONSince 2006,the overall drug resistance rate has gradually declined,but it has recovered in the past two years.The drug resistance rate was high,but the extensively drug-resistant rate was controlled at a lower level.The drug resistance rates to S,H,R,E reached the lowest point in 2008 and have rebounded in the past three years.
OBJECTIVE To retrospectively analyze the resistance of Mycobacterium tuberculosis to 4 kinds of firstline and some kinds of second-line anti-TB drugs during 2006-2017 in Tianjin,and to provide scientific reference for diagnosis and treatment of tuberculosis.METHODS A total of 20 212 strains isolated from 77739 tuberculosis patients treated in the hospital during Jan.2006 to Dec.2017 were selected,then the drug susceptibility test results for 4 kinds of first-line[isoniazid(H),rifampicin(R),ethambutol(E),streptomycin(S)]and some kinds of second-line anti-TB drugs [including aminosalicylate(PAS),amikacin(AK),levofloxacin(V),ofloxacin(O),capreomycin(Cm),kanamycin(Km),ciprofloxacin and protionamid(Pto)]were traced,and the change in drug resistance was analyzed.RESULTS A total of 20 212 strains of M tuberculosis were detected from 2006-2017,the mono-resistant rate,poly-resistant rate and multidrug-resistant rate were 13.68%,8.80%and 12.29%,respectively.There were 74 strains of extensively drug-resistant M tuberculosis strains from 2013 to 2017,accounting for 1.50% of the total strains in the same period.The total drug-resistance rate from 2006 to 2017 was between 31.00% and 40.89%.There were 15118 strains cultured positive by using BACTEC MGIT960-TB liquid culture method from 2006 to 2017,and the order of drug resistance was H>S>R>E.There were 5 094 strains cultured positive by using modified Roche medium culture method from 2013 to 2017,and the order of drug resistance was S>H>R>E>PAS.The resistance rate to ofloxacin and capreomycin was 15.92%(690/4 334)and1.76%(73/4 155)respectively.CONCLUSIONSince 2006,the overall drug resistance rate has gradually declined,but it has recovered in the past two years.The drug resistance rate was high,but the extensively drug-resistant rate was controlled at a lower level.The drug resistance rates to S,H,R,E reached the lowest point in 2008 and have rebounded in the past three years.
引文
[1] Pai M,Schito M.Tuberculosis diagnostics in 2015:Landscape,priorities,needs,and prospects[J].J Infect Dis,2015,211(suppl 2):S21-S28.
[2] World Health Organization.Global tuberculosis report 2014[S].Geneva:World Health Organization,2014.
[3]世界卫生组织2018年全球结核病报告.
[4]王黎霞,成诗明,陈明亭,等.2010年全国第五次结核病流行病学抽样调查报告[J].中国防痨杂志[J],2012,34(8):485-508.
[5]季乐财,余卫业,谭卫国,等.季乐财,余卫业,谭卫国,等.深圳市2000-2016年初治耐药结核病流行趋势分析[J].中国热带医学,2018,18(6):568-571.
[6]徐峰,朱育银,车洋,等.宁波市结核分支杆菌感染患者耐药趋势分析[J],中华医院感染学杂志,2015,25(19):4438-4440.
[7]张丽霞,王静宜,吴敏,等.天津市一线抗结核药物的耐药变迁与临床督导机制的研究[J]中华医院感染学杂志,2015,25(2):336-338.
[8]中国防痨协会.耐药结核病化学治疗指南(2015)[J].中国防痨杂志,2015,37(5):421-469.
[9]邱巍.结核病诊断实验室检验规程[M].北京:中国教育文化出版社,2006.30-35.
[10]李君,单志力,朱小梅,等.结核分枝杆菌对一线抗结核药物的耐药性分析[J]中华医院感染学杂志,2018,28(13):1925-1928.
[11]赵冰,宋媛媛,逄宇,等.中国耐多药结核分支杆菌二线抗结核药物敏感性分析[J],中国防痨杂志,2013,35(10):831-834.
[12]孔伟利,孟令俊,白大鹏,等.结核分支杆菌对氧氟沙星、左氧氟沙星体内外耐药监测[J],临床荟萃,2011,26(3):200-203.
[13]王钰.1250例肺结核患者耐药情况分析[D].吉林大学,2015.
[14] Chang KC,Nuermberger E,Sotgiu G,et al.New drugs and regimens for tuberculosis[J]Respirology 2018,23(11):978-990.
[15] Mamatha HG,Shanthi V.Baseline resistance and cross-resistance among fluoroquinolones in multidrug-resistant Mycobacterium tuberculosis isolates at a national reference laboratory in India[J].J Glob Antimicrob Resist,2018,12:5-10.
[16] Chaoui I,Oudghiri A,El Mzibri M.Characterization of gyrA and gyrB mutations associated with fluoroquinolone resistance in Mycobacterium tuberculosis isolates from Morocc[J].J Glob Antimicrob Resist,2018,12:171-174.
[17] JAIN K,DESAI M,SOLANKI R,et al.Treatm ent outcome of standardized regimen in patients with multidrug-resistant tuberculosis[J].J Pharmacol Pharmacother,2014,5(2):145-149.
[18] Herea L,Jimenz S,Valverde A,et al.Molecular analysis of rifampicin-resistent Mycobacterium tuberculosis isolated in Spain(1996-2001).Description of new mutations in the rpoB gene and review of the literature[J].Int J Antimicrob Agents,2003,21(5):403-408.
[19]阴灵芳,孙惠平,周永,等.耐利福平作为筛选耐多药结核病指标的评估[J]临床肺科杂志,2013,18(9):1656-1658.
[20] Kendall EA,Cohen T,Mitnick CD,et al.Second line drug susceptibility testing to inform the treatment of rifampin-resistant tuberculosis:aquantitative perspective[J].Int J Infect Dis,2017,56:185-189.
[21]Daniel-Wayman S,Abate G,Barber DL,et al.Advancing translational science for pulmonary NTM infections:a roadmap for research[J]Am J Respir Crit Care Med,2018.
[22] Cox H,Ramma L,Wilkinson L,et al.Cost per patient of treatment for rifampicin-resistant tuberculosis in a community-based programme in Khayelitsha,South Africa[J].Trop Med Int Health,2015,20(10):1337-1345.
[23] Zhang Q,Wu Z,Zhang Z,et al.Efficacy and effect of free treatment on multidrug-resistant tuberculosis[J].Exp Ther Med,2016,11(3):777-782.
[2] World Health Organization.Global tuberculosis report 2014[S].Geneva:World Health Organization,2014.
[3]世界卫生组织2018年全球结核病报告.
[4]王黎霞,成诗明,陈明亭,等.2010年全国第五次结核病流行病学抽样调查报告[J].中国防痨杂志[J],2012,34(8):485-508.
[5]季乐财,余卫业,谭卫国,等.季乐财,余卫业,谭卫国,等.深圳市2000-2016年初治耐药结核病流行趋势分析[J].中国热带医学,2018,18(6):568-571.
[6]徐峰,朱育银,车洋,等.宁波市结核分支杆菌感染患者耐药趋势分析[J],中华医院感染学杂志,2015,25(19):4438-4440.
[7]张丽霞,王静宜,吴敏,等.天津市一线抗结核药物的耐药变迁与临床督导机制的研究[J]中华医院感染学杂志,2015,25(2):336-338.
[8]中国防痨协会.耐药结核病化学治疗指南(2015)[J].中国防痨杂志,2015,37(5):421-469.
[9]邱巍.结核病诊断实验室检验规程[M].北京:中国教育文化出版社,2006.30-35.
[10]李君,单志力,朱小梅,等.结核分枝杆菌对一线抗结核药物的耐药性分析[J]中华医院感染学杂志,2018,28(13):1925-1928.
[11]赵冰,宋媛媛,逄宇,等.中国耐多药结核分支杆菌二线抗结核药物敏感性分析[J],中国防痨杂志,2013,35(10):831-834.
[12]孔伟利,孟令俊,白大鹏,等.结核分支杆菌对氧氟沙星、左氧氟沙星体内外耐药监测[J],临床荟萃,2011,26(3):200-203.
[13]王钰.1250例肺结核患者耐药情况分析[D].吉林大学,2015.
[14] Chang KC,Nuermberger E,Sotgiu G,et al.New drugs and regimens for tuberculosis[J]Respirology 2018,23(11):978-990.
[15] Mamatha HG,Shanthi V.Baseline resistance and cross-resistance among fluoroquinolones in multidrug-resistant Mycobacterium tuberculosis isolates at a national reference laboratory in India[J].J Glob Antimicrob Resist,2018,12:5-10.
[16] Chaoui I,Oudghiri A,El Mzibri M.Characterization of gyrA and gyrB mutations associated with fluoroquinolone resistance in Mycobacterium tuberculosis isolates from Morocc[J].J Glob Antimicrob Resist,2018,12:171-174.
[17] JAIN K,DESAI M,SOLANKI R,et al.Treatm ent outcome of standardized regimen in patients with multidrug-resistant tuberculosis[J].J Pharmacol Pharmacother,2014,5(2):145-149.
[18] Herea L,Jimenz S,Valverde A,et al.Molecular analysis of rifampicin-resistent Mycobacterium tuberculosis isolated in Spain(1996-2001).Description of new mutations in the rpoB gene and review of the literature[J].Int J Antimicrob Agents,2003,21(5):403-408.
[19]阴灵芳,孙惠平,周永,等.耐利福平作为筛选耐多药结核病指标的评估[J]临床肺科杂志,2013,18(9):1656-1658.
[20] Kendall EA,Cohen T,Mitnick CD,et al.Second line drug susceptibility testing to inform the treatment of rifampin-resistant tuberculosis:aquantitative perspective[J].Int J Infect Dis,2017,56:185-189.
[21]Daniel-Wayman S,Abate G,Barber DL,et al.Advancing translational science for pulmonary NTM infections:a roadmap for research[J]Am J Respir Crit Care Med,2018.
[22] Cox H,Ramma L,Wilkinson L,et al.Cost per patient of treatment for rifampicin-resistant tuberculosis in a community-based programme in Khayelitsha,South Africa[J].Trop Med Int Health,2015,20(10):1337-1345.
[23] Zhang Q,Wu Z,Zhang Z,et al.Efficacy and effect of free treatment on multidrug-resistant tuberculosis[J].Exp Ther Med,2016,11(3):777-782.