耐多药结核分枝杆菌临床分离株30株对氟喹诺酮类及二线注射类抗结核药敏感性的分析

Fluoroquinolones and second-line injectable anti-TB drug susceptibility analysis in 30 multidrug-resistant Mycobacterium tuberculosis clinical isolates

目的了解耐多药结核分枝杆菌对氟喹诺酮类和(或)二线注射类抗结核药物的敏感性情况。方法收集2011年6～9月采用Bactec-MGIT 960检测的30株耐多药结核分枝杆菌临床分离株,检测其对氟喹诺酮类及二线注射类抗结核药的药敏结果并进行分析。结果 30株耐多药结核分枝杆菌菌株对氟喹诺酮类和二线注射类抗结核药物耐药共21株(70%)。单药耐药依次为:氧氟沙星耐药19株(63.33%),莫西沙星耐药13株(耐药率43.33%),左氧氟沙星耐药10株(耐药率33.33%),阿米卡星耐药9株(耐药率30%),卷曲霉素最少(26.67%)。氧氟沙星耐药率高于左氧氟沙星耐药和三种氟喹诺酮类药同时耐药,差异有统计学意义(P=0.038)。氟喹诺酮类任意耐药及两种注射类药物任意耐药共8株[即广泛耐药结核病(XDR-TB)]。氟喹诺酮类任意耐药及两种注射类药物敏感为11株,氟喹诺酮类均敏感及两种注射类药物任意耐药为2株,相比差异有统计学意义(P=0.001)。结论耐多药结核病(MDR-TB)临床分离株对氟喹诺酮类药物耐药严重,氟喹诺酮类药物的耐药也是早期XDR-TB菌株的耐药主要形式。因此,氧氟沙星不建议作为MDR-TB的治疗用药。而MDR-TB临床分离株对阿米卡星和卷曲霉素敏感性较好,推荐可用于MDR-TB的首选药物。

Objective To investigate the drug susceptibility of fluoroquinolones and/or second-line injectable anti-TB drugs in multidrug resistant （MDR） Mycobacterium tuberculosis. Methods A total of 30 clinical isolates of MDR Mycobacterium tuberculosis were gathered, identifieated by Bactec-MGIT 960, tested for drug susceptibility of fluoroquinolones and second-line injectable anti-TB drug, and the results were analysed. Results Twenty one isolates were resistant to fluoroquinolones or second-line injectable anti-TB drug in 30 MDR Mycobacterium tuberculosis isolates. Single drug resistance followed by：ofloxacin resistance was 19 isolates（resistance rate 63.33% ） moxifloxacin resistance was 13 isolates （ resistance rate 43.33% ） ; levofloxacin resistance was 10 isolates（ 33.33% ） ; Amikacin resistance was 9 isolates （30%）and with capreomycin 8 isolates （26. 67% ）. The resistant rate of Ofloxacin was higher than that of ievofloxacin and total of the three fluoroquinolones, and there was statistically significance（P = 0. 038）. 8 isolates were resistant to any one of fluoroquinolones and at least one of two injectable drugs （XDR-TB）. 11 isolates were resistant to any one of fluoroquinolones and also sensitive to two injectable drugs. 2 isolates were sensitive to all three fluoroquinolones and resistant to at least one of two injectable drugs. The difference was statistically significant（P = 0. 001 ）. Conclusions MDR-TB clinical isolates are resistant to fluoroquinolones seriously. Meanwhile, resistance to fluoroquinolones was a mainly form of pre-XDR-TB isolates. Therefore, Ofloxacin is not recommended for the treatment of MDR-TB. However, MDR-TB clinical isolates are more sensitive to amikacin and capreomycin which can be applied to the treatment of MDR-TB.