摘要
目的了解重庆市耐多药结核病(multidrug-resistant tuberculosis,MDR-TB)临床菌株二线注射类药物的耐药性及交叉耐药情况,为重庆市MDR-TB患者合理选择注射类药物进行治疗提供依据。方法收集2015年1月至2017年6月重庆市39个区(县)MDR-TB患者结核分枝杆菌临床分离株229株,通过微量肉汤稀释法检测卡那霉素(kanamycin,Km)、阿米卡星(amikacin,Am)和卷曲霉素(capreomycin,Cm)的敏感性,分析耐药及交叉耐药情况,并用PCR测序方法对交叉耐药菌株进行基因分析。结果在229株MDR菌株中,Km和Am交叉耐药27株,分别占79.41%(27/34)、100.00%(27/27);Km、Am与Cm交叉耐药18株,分别占Km、Am和Cm耐药株的52.94%(18/34)、66.67%(18/27)和94.74%(18/19)。在27株Km和Am及18株Km、Am和Cm交叉耐药株中,rrs基因A1401G突变率分别为74.07%、72.22%,均高于其他基因突变(P<0.01)。结论rrs基因A1401G突变是Km、Am与Cm交叉耐药的分子基础。Km和Am、Km和Cm间均为部分交叉耐药,对Km耐药者,可选用Am和Cm进行治疗。
Objective To understand the resistance and cross-resistance to second-line injectable drugs(SLIDs)of multidrug-resistant Mycobacterium tuberculosis(MDR-TB)isolates in SLIDs to treat MDR-TB patients.Methods Two hundred and twenty-nine MDR-TB clinical strains were collected from 39 Districts(Counties)of Chongqing during January 2015 and June 2017 and drug susceptibility to kanamycin(Km),amikacin(Am)and capreomycin(Cm)were determined using microdilution test.Cross-resistant MDR-TB strains were sequenced for rrs gene mutation.Results Of 229 MDR-TB isolates,27 were cross-resistant to Km and Am,accounting for 79.41%(27/34)and 100.00%(27/27)with A1401 G mutation rate in rrs of 74.07%.18 isolates were found to be cross-resistant to Km,Am and Cm,accounting for 52.94%(18/34),66.67%(18/27)and 94.74%(18/19),respectively with A1401 G mutation rate of 74.07%.The overall mutation rate of rrs gene was higher than that of other genes(P<0.01).Conclusions A1401 G mutation in rrs is the leading cause of cross-resistance of MDR-TB isolates to SLIDs in Chongqing.The drug resistances to Km,Am and Km,Cm were partial,therefore,for the Km-resistant isolates,Am and Cm can be used for MDR-TB treatment.
作者
沈静
陈林
胡彦
刘洁
SHEN Jing;CHEN Lin;HU Yan;LIU Jie(Tuberculosis Reference Laboratory of Chongqing Tuberculosis Control Institute,Chongqing 400050,China)
出处
《中国预防医学杂志》
CAS
CSCD
2020年第8期874-878,共5页
Chinese Preventive Medicine
基金
重庆市基础研究与前沿探索项目(cstc2018jcyjAX0589)
重庆市卫生计生委医学科研项目(2016MSXM106)