云南省涂阳肺结核病例耐药监测分析

Drug resistance of Mycobacterium tuberculosis strains isolated from smear-positive pulmonary tuberculosis patients in Yunnan province: surveillance data analysis

目的了解云南省涂阳肺结核病例的耐药情况,为制定肺结核耐药防治策略提供参考依据。方法以云南省2008年涂阳肺结核病例数为基数,采用按样本容量比例概率抽样方法抽取云南省30个县(市、区)监测点2009—2011、2013、2014、2015年登记的5 591例涂阳肺结核病例进行培养、初步菌型鉴定和药敏试验,分析涂阳肺结核病例的耐药情况。结果云南省5 591例涂阳肺结核病例菌型鉴定有5 319株为结核分枝杆菌菌株,共检出269例耐多药病例,其中19例为广泛耐药病例,耐多药率和广泛耐药率分别为5.06%和0.36%;2009—2011、2013、2014和2015年涂阳肺结核病例的耐多药率分别为7.46%、4.67%、3.97%和4.28%,广泛耐药率分别为0.39%、0.19%、0和0.60%,差异均有统计学意义(均P <0.05);2009—2011、2013、2014、2015年非耐多药肺结核病例对氧氟沙星和卡那霉素的耐药率分别为1.53%和7.29%、2.90%和3.60%、2.27%和0.31%、2.63%和1.95%,均低于耐多药肺结核病例的15.79%和11.58%、 14.29%和14.29%、 5.00%和2.50%、 25.88%和15.29%, 2组病例除2014年氧氟沙星和2009—2011年卡那霉素耐药率差异无统计学意义外,其余年份差异均有统计学意义(均P <0.05)。结论云南省涂阳肺结核病例耐多药率近年来有一定程度降低,但仍在一定范围内波动,应避免耐多药结核菌的传播,并重视临床治疗过程中氧氟沙星和卡那霉素等二线抗结核药物滥用的问题。

Objective To investigate the status of drug resistance of Mycobacterium tuberculosis（MTB） strains isolated from smear-positive pulmonary tuberculosis patients in Yunnan province and to provide evidences for developing strategies for the prevention and treatment of drug resistance tuberculosis. Methods Based on the number of reported smear-positive pulmonary tuberculosis cases in Yunnan province in 2008, 30 counties were selected with probability proportional to size（PPS） sampling and sputum specimens were collected from 5 591 smear-positive pulmonary tuberculosis patients reported in the 30 counties during the periods from 2009 to 2011 and from 2013 to 2015 for isolation, identification, and drug susceptibility test（DST） of MTB. Results Totally 5 319 MTB strains were isolated from all the patients. For all the MTB strains isolated, 269 multidrug-resistant（MDR） and 19 extensively drug-resistant（XDR） strains were detected; the rate of MDR and XDR were 5.06% and 0.36%; the MDR rates were 7.46%, 4.67%, 3.97%, and 4.28% and the XDR rates were0.39%, 0.19%, 0.00%, and 0.60% for the MTB strains isolated during 2009-2011, 2013, 2014, and 2015, respectively, with significant difference in the rates among various time periods（all P〈0.05）. Compared to those of the MDR strains isolated during 2009-2011, 2013, 2014, and 2015, the ofloxacin-and kanamycin-resistant rate of the isolated non-MDR strains were lower（for ofloxacin-resistant： 1.53% vs. 15.79%, 7.29% vs. 11.58%, 2.90% vs. 14.29%, and 3.60% vs. 14.29%; for kanamycin-resistant： 2.27% vs. 5.00%, 0.31% vs. 2.50%, 2.63% vs. 25.88%, and 1.95% vs. 15.29%） and all the differences in the rates between the two groups were of significance（all P〈0.05）, except for the difference in ofloxacin-resistant rate in2014 and in ofloxacin-and kanamycin-resistant rate during 2009-2011. Conclusion The drug resistance rate decrased to some extent for the MTB strains isolated from smear-positive pulmonary tuberculosis patients in Yunnan province in recent years but unreasonable clinic usage of second-line anti-TB drugs such as ofloxacin and kanamycin needs to be concerned for the prevention of MDR among pulmonary tuberculosis patients.