宁波市结核分枝杆菌感染患者耐药趋势分析

Analysis of drug resistance trend of patients infected by Mycobacterium tuberculosis in Ningbo

目的回顾性调查某市级定点医院结核分枝杆菌感染患者耐药性与变化趋势,为进一步完善肺结核预防治疗工作提供科学依据。方法收集2012-2014年该定点医院收治的结核患者875例,分初治和复治两组,分析经宁波市结核病实验室细菌学检查,包括痰菌涂片、菌种鉴定、痰培养结果和结核分枝杆菌药敏试验等病例耐药性、变化趋势和治疗药物应用。结果 875例患者中检出结核分枝杆菌688株,检出率78.6%,初治590例、复治98例;688株结核分枝杆菌耐药197株,总耐药率为28.6%,其中初始耐药率为23.7%,获得性耐药率为58.2%;单一耐药71株,单耐药率10.3%;对4种抗结核药物的单耐药率由高到低依次为异烟肼、链霉素、利福平、乙胺丁醇;耐多药96株,耐多药率13.9%,3年间,总耐药率分别为21.5%、26.9%、33.6%,单耐药率分别为7.9%、11.9%、10.7%,耐多药率分别为9.0%、12.4%、17.6%。结论该院耐药肺结核形势严峻,应进一步加强预防措施,尽可能防止耐多药肺结核作为新发感染的传染源造成公共卫生隐患。

OBJECTIVE To investigate the drug resistance and change trend of patients infected by Mycobacterium tuberculosis （M TB） in a certain hospital in Ningbo so as to provide scientific basis for prevention and treatment of MTB .METHODS Totally 875 MTB patients were collected from 2012 to 2014 in the hospital and they were divid‐ed into initial treatment group and retreatment group .The bacteriological inspections ,including sputum smear , species identification ,sputum culture and drug sensitivity test in laboratory were conducted to them .RESULTS From 875 cases of hospitalized patients ,688 strains of MTB were detected and the rate was 78 .6% .The initial treatment group had 590 patients and the retreatment group owned 98 cases .The results found that 197 strains of MTB were resistant and the total drug resistance rate was 28 .6% .Besides ,initial drug resistance rate was 23 .7%and the acquired drug resistance rate was 58 .2% .Totally 71 strains were single resistant ,accounting for 10 .3% . The four antituberculosis drugs ranked by resistance rate from high to low isoniazid ,streptomycin ,rifampicin and ethambutoland .A total of 96 strains were multi‐drug resistant and the rate was 13 .9% .During the three years , the total drug resistance rates were 21 .5% ,26 .9% ,33 .6% respectively .Single drug resistance rates were 7 .9% ,11 .9% ,10 .7% .Multi‐drug resistance rates were 9% ,12 .4% ,17 .6% .CONCLUSION The situation of drug resistant tuberculosis in this hospital is terrible .Measures should be taken to further prevent multi‐drug re‐sistant TB from becoming new infection source that will cause hidden problems of public health .