三种注射用抗结核药物对结核分枝杆菌的耐药情况分析

Analysis on drug resistance of Mycobacterium tuberculosis to three injectable antituberculous drugs

目的探讨链霉素、卷曲霉素和阿米卡星对结核分枝杆菌的耐药情况,为临床用药提供理论依据。方法对2008年8月至2009年7月间在上海市肺科医院结核科住院的448例痰结核分枝杆菌培养阳性的肺结核患者的药敏结果进行分析。结果对链霉素耐药的189例患者中分别有59例(31.2%)、52例(27.5%)同时耐阿米卡星和卷曲霉素(χ2=0.625,P=0.429);阿米卡星耐药的61例患者中耐链霉素的有59例(96.7%),卷曲霉素耐药的57例中耐链霉素的有52例(91.2%)(χ2=1.593,P=0.207);61例耐阿米卡星的患者中有47例(77%)同时耐卷曲霉素,57例卷曲霉素耐药的患者中有47例(82.5%)同时对阿米卡星耐药,两者比较无显著差异(χ2=0.532,P=0.466)。结论链霉素和阿米卡星、卷曲霉素之间主要表现为单向交叉耐药,卷曲霉素与阿米卡星间可能存在相当高的双向交叉耐药。

Objective To investigate the drug resistance of Mycobacterium tuberculosis to strep- tomycin,capreomycin and amikacin and to provide the scientific evidences for clinical treatment. Methods A retrospective study was adopted to analyze the results of drug susceptibility testing （DST） in 448 inpatients with pulmonary tuberculosis confirmed by culture with BACTEC MGIT 960 in our hospital during August 2008 to July 2009. Results Of 189 streptomycin-resistant isolates, 59 （31.2%） strains were resistant to amikacin and 52 （27.5%）strains were resistant to capreomycin. Of 61 kanamycin-resistant isolates, 59 （96.7%） strains were resistant to streptomycin. There were 52 strains resistant to streptomycin in 57 capreomycin-resistant isolates. （X^2= 1. 593, P=0. 207）. We also found that 47（77%） strains were resistant to capreomycin in 61 amikacin-resistant isolates. There were 47（82.5%） strains resistant to amikacin in 57 capreomycin-resistant isolates. Conclusion The drug resistance of mycobacterium tuberculosis to streptomycin and amikatin is a monodirectional resistance. Streptomycin and capreomycin is also a monodirectional resistance. But capreomycin and amikacin is cross-resistant.