氟喹诺酮类药物在耐多药肺结核病防治中的耐药情况分析

Analysis of drug resistance of fluoroquinolones in the prevention and treatment of multidrug-resistant tuberculosis

目的研究氟喹诺酮类药物在耐多药肺结核病的耐药情况,并分析其应用价值。方法选取2016年1-12月于河北省胸科医院住院的耐多药肺结核病患者155例,使用MGIT 960液体快速培养联合快速药敏试验检测获得的临床分离株对氧氟沙星(ofloxacin,OFX)、左氧氟沙星(levofloxacin,LFX)、环丙沙星(ciprofloxacin,CFX)、莫西沙星(moxifloxacin,MFX)和加替沙星(gatifloxacin,GFX)药物的敏感性,进一步分析交叉耐药情况。结果河北地区耐多药肺结核病趋于年轻化,年轻患者中主要以初治为主,而中老年患者则以复治为主。OFX、LFX、CFX、MFX和GFX在复治耐多药患者中的耐药率58.24%(53/91)、58.24%(53/91)、56.04%(51/91)、56.04%(51/91)和12.09%(11/91)均显著高于初治中耐药率39.06%(25/64)、42.19%(27/64)、39.06%(25/64)、39.06%(25/64)和1.56%(1/64),差异均有统计学意义(χ^(2)=5.529,χ^(2)=3.878,χ^(2)=4.336,χ^(2)=4.336,χ^(2)=5.828,P<0.05)。氟喹诺酮类药物之间存在明显交叉耐药,而大部分耐其他4种氟喹诺酮类药物的患者仍对GFX敏感。结论河北地区耐多药肺结核病形势依旧严峻,年轻患者以初治为主,中老年患者以复治为主,5种氟喹诺酮类药物耐药率复治均显著高于初治,彼此间存在明显交叉耐药,在临床治疗时仍应结合药敏试验或最低抑菌浓度(minimum inhibitory concentration,MIC)法谨慎选择药物,GFX可考虑作为治疗耐多药肺结核病中氟喹诺酮类药物的首选。

Objective The current analysis was set to study the drug resistance of fluoroquinolones in multidrug-resistant tuberculosis and analyze its application value.Methods A total of 155 patients with multidrug-resistant pulmonary tuberculosis admitted to the Hebei Chest Hospital from January to December in 2016 were enrolled.The clinical isolates obtained by MGIT960 liquid rapid culture combined with rapid susceptibility testing were tested for the sensitivity of ofloxacin(OFX),levofloxacin(LFX),ciprofloxacin(CFX),moxifloxacin(MFX),and gatifloxacin(GFX) drugs,and analyzed the cross-resistance between the five fluoroquinolones.Results Multidrug-resistant tuberculosis in Hebei tended to be younger.The young patients were mainly treated with initial treatment,while the middle-aged and elderly patients were mainly treated with re-treatment.The drug resistance rates of OFX,LFX,CFX,MFX and GFX in retreatment of MDR-TB patients were 58.24%(53/91),58.24%(53/91),56.04%(51/91),56.04%(51/91) and 12.09%(11/91),which were significantly higher than the resistance rate in the initial treatment 39.06%(25/64),42.19%(27/64),39.06%(25/64),39.06%(25/64) and 1.56%(1/64),the differences were statistically significant(χ^(2)=5.529,χ^(2)=3.878,χ^(2)=4.336,χ^(2)=4.336,χ^(2)=5.828,P<0.05).There was significant cross-resistance between fluoroquinolones and the majority of patients who were resistant to the other four fluoroquinolones remained sensitive to GFX.Conclusion The situation of multidrug-resistant tuberculosis in Hebei is still severe.The young patients are mainly initial treatment,and middle-aged and elderly patients are mainly re-treatment.The drug resistance rates of the five fluoroquinolone drugs in re-treatment of multidrug-resistant patients were significantly higher than those of newly-treated patients.The five fluoroquinolones have obvious cross-resistance with each other,and should be carefully selected in combination with the drug sensitivity test or MIC method in clinical treatment.GFX can be considered as the first choice for the treatment of fluoroquinolones in multidrug-resistant tuberculosis.