河南省南阳市1961株结核分枝杆菌药敏耐药分析

Analysis of drug resistance of 1961 strains of Mycobacterium tuberculosis in Nanyang City,Henan Province

目的了解南阳市结核病患者分离结核分枝杆菌复合群菌株对6种抗结核药物的耐药情况,为南阳市结核病防控工作提供依据。方法选取南阳市第六人民医院收集的2022年1月至2023年9月南阳市结核病可疑患者的结核分枝杆菌复合群分离株1961株,其中有1819株分离自初治患者,142株分离自复治患者,由此分为初治组和复治组。对异烟肼(isoniazid,INH)、利福平(rifampicin,RFP)、乙胺丁醇(ethambutol,EMB)、链霉素(streptomycin,SM)、氧氟沙星(ofloxacin,OFX)和卡那霉素(kanamycin,KM)进行传统表型药敏比例法试验。结果1961株的总耐药率为28.00%(549/1961),单耐药率为17.24%(338/1961),多耐药率为5.61%(110/1961),耐多药率为4.95%(97/1961),准广泛耐药为1.43%(28/1961)。通过两组比较,总耐药率、耐多药率、准广泛耐药率的差异均有统计学意义(P<0.05)。通过两组比较,单耐药率、多耐药率的差异均无统计学意义(P>0.05)。549株耐药菌株对6种抗结核药物表现出26种耐药模式。任一耐药率排前3位的为SM(15.81%)、INH(13.26%)和OFX(7.34%)。单耐药率前3位的药物依次为SM(7.75%)、OFX(4.28%)和INH(3.67%)。多耐药排名第1位的组合为INH+SM(3.42%),耐多药排名第1位的组合为INH+RFP(1.12%)。结论南阳市结核分枝杆菌复合群的耐药情况较为严重,需要加强对患者的管理,规律用药,提高治愈率,同时要加快对耐药患者发现速度,减少耐药结核病的流行传播。

Objective To understand the drug resistance of Mycobacterium tuberculosis complex strains isolated from tuberculosis patients in Nanyang City to six kinds of anti-tuberculosis drugs,and to provide support for the prevention and control of tuberculosis in Nanyang City.Methods 1961 strains of Mycobacterium tuberculosis complex isolates from suspected patients in Nanyang City from January 2022 to September 2023 were collected.Among them,1819 strains were isolated from primary treatment patients and 142 strains were isolated from retreatment patients,so they were divided into primary treatment group and retreatment group.Six anti-tuberculosis drugs,isoniazid(INH),rifampicin(RFP),ethambutol(EMB),streptomycin(SM),ofloxacin(OFX)and kanamycin(KM),were used for sensitivity tests.Results The total resistance rate of the 1961 Mycobacterium tuberculosis complex strain was 28.00%(549/1961),the monoresistance rate was 17.24%(338/1961),the poly-resistance rate was 5.61%(110/1961),and the multidrug resistance rate was 4.95%(97/1961),pre-XDR rate was 1.43%(28/1961).There was a statistically significant difference in the total drug resistance rate,multidrug resistance rate and pre-XDR between newly treated patients and replicated patients(all P<0.05).There was no statistically significant difference in the single drug resistance rate and poly drug resistance rate between newly treated patients and replicated patients(all P>0.05).There were 26 drug resistance patterns for 6 anti-tuberculosis drugs of 549 drug-resistant strains.The top three drug resistance rates were streptomycin(15.81%),isoniazid(13.26%),and ofloxacin(7.34%).The top three drugs with mono drug resistance rate were streptomycin(7.75%),ofloxacin(4.28%),isoniazid(3.67%).INH+SM(3.42%)ranked first in poly drug resistance,and INH+RFP(1.12%)ranked first in multi-drug resistance.Conclusions The drug resistance of Mycobacterium tuberculosis complex in Nanyang City is serious.It is necessary to strengthen the management of patients,to use drugs regularly,to improve the cure rate,to speed up the discovery of drug resistant patients,and to reduce the prevalence of drug resistant tuberculosis.