骨与关节结核患者病原菌分布与耐药性分析

Distribution and drug resistance of pathogens isolated from patients with osteoarticular tuberculosis

目的研究骨与关节结核病患者病原菌分布及耐药性,为临床诊治骨与关节结核提供参考。方法以2012年1月-2014年1月于医院就诊的72例骨与关节结核患者为研究对象,运用BACTEC MGI 960系统进行菌种鉴定、药敏试验和分枝杆菌属培养,对菌种的分布、耐药及分枝杆菌属阳性率进行分析。结果培养4周时分枝杆菌属培养阳性25株阳性率为34.72%,培养至8周时升高至42株占58.33%,两者差异有统计学意义(P<0.05);分枝杆菌属中分离出结核分枝杆菌25株占59.52%、牛分枝杆菌占11株26.19%、非结核分枝杆菌6株占14.29%;进行42株分枝杆菌属进行药敏试验,出现耐药菌株17株耐药率40.48%,其中牛分枝杆菌5株、结核分枝杆菌6株、非结核分枝杆菌6株。结论延长培养时间可增加阳性培养率,骨与关节结核病原菌主要为结核分枝杆菌,其次为非结核分枝杆菌和牛分枝杆菌,且有较高的耐药率。

OBJECTIVE To investigate the distribution and drug resistance of the pathogens isolated from the patients with osteoarticular tuberculosis so as to provide guidance for clinical diagnosis and treatment of the osteoarticular tuberculosis.METHODS A total of 72 patients with osteoarticular tuberculosis who were treated in the hospitals from Jan 2012 to Jan 2014 were recruited as the study objects,the isolated pathogens were identified by using BACTEC MGI 960 system,the drug susceptibility testing was performed,the culture of Mycobacterium was carried out.The distribution,drug resistance of the pathogens and the positive rates of Mycobacterium were observed.RESULTS Totally 25（34.72%）strains of Mycobacterium were cultured positive at week 4of the culture and 42（58.33%）strains of Mycobacterium were cultured positive at week 8of the culture,with significant difference（P〈0.05）.Of the isolated Mycobacteriumstrains,25（59.52%）strains were Mycobacteriumtuberculosis,11（26.19%）strains were Mycobacteriumbovis,and 6（14.29%）strains were non-Mycobacterium tuberculosis.The results of the drug susceptibility testing for 42 strains of Mycobacterium showed that 17（40.48%）strains were resistant to antibiotics,including 5strains of M.bovis,6strains of M.tuberculosis,and 6strains of non-M.tuberculosis.CONCLUSION The delay of the time of culture may increase the positive culture rate.The M.tuberculosis is the predominant species of pathogens isolated from the patients with osteoarticular tuberculosis,followed by the non-M.tuberculosis and M.bovis,and the drug resistance rates are high.