2015—2019年南充市结核分枝杆菌耐药情况及流行特征分析

Epidemiological characteristics of drug resistance of mycobacterium tuberculosis in Nanchong from 2015 to 2019

目的了解南充市结核分枝杆菌耐药情况,为临床结核病治疗及该地区结核病防控提供依据。方法采用结核分枝杆菌比例法药敏试验对2015—2019年南充市分离培养得到的结核分枝杆菌进行异烟肼(INH)、利福平(RFP)、链霉素(SM)、乙胺丁醇(EMB)、氧氟沙星(OFX)、卡拉霉素(KM)药物敏感性检测及菌种鉴定,并使用SPSS 17.0统计软件进行χ^(2)检验,以P<0.05为差异有统计学意义。结果2015—2019年共分离鉴定出结核分枝杆菌954株,其中703株为全敏感,251株为耐药,总耐药率为26.31%,耐多药率为11.84%;耐药顺序为耐INH(16.88%)、耐SM(14.68%)、耐RFP(12.58%)、耐OFX(12.05%)、耐EMB(6.39%)、耐KM(1.47%);男女肺结核患者总耐药率分别为26.65%、25.00%(χ^(2)=0.218,P=0.640),耐多药率分别为11.48%、13.27%(χ^(2)=0.477,P=0.490),差异均无统计学意义;初治和复治患者总耐药率分别为19.92%、53.59%(χ^(2)=85.750,P<0.001),耐多药率分别为6.47%、34.81%(χ^(2)=112.793,P<0.001),差异均有统计学意义。结论南充市耐药结核病疫情较严峻,特别是复治患者耐药率和耐多药率都极高,应进一步加强耐药监测以指导临床合理用药,并采取针对性措施加以防控。

Objective To understand the epidemiological characteristics of drug resistance of Mycobacterium tuberculosis(MTB) in Nanchong City, so as to provide a basis for clinical tuberculosis(TB) treatment and TB prevention and control in the region. Methods Mycousingbacterium tuberculosis(MTB) isolated from Nanchong city from 2015 to 2019 was tested for drug sensitivity of isoniazid(INH), rifampicin(RFP), streptomycin(SM), ethambutol(EMB), ofloxacin(OFX),and kalamycin(KM) by proportional method. SPSS 17.0 statistical software was used for chi-square tests,and P<0.05 was considered as statistically significant difference. Results A total of954 strains of Mycobacterium tuberculosis were isolated and identified in 2015 to 2019, and 703 strains were fully susceptible and 251 strains were resistant. The overall drug resistance rate was26.31% and the multidrug resistance rate was 11.84%. The order of rate of drug resistance was INH(16.88%),SM(14.68%),RFP(12.58%),OFX(12.05%),EMB(6.39%),and KM(1.47%).The overall drug resistance rates for male and female TB patients were 26.65% and 25.00% (χ^(2)=0.218,P=0.640),and the multidrug resistance rates for male and female TB patients were 11.48%and 13.27% (χ^(2)=0.477, P=0.490), respectively;the differences were not statistically significant.The overall drug resistance rate in primary and retreatment patients was 19.92% and 53.59% (χ^(2)=85.750,P<0.001),the multidrug resistance rate in primary and retreatment patients was 6.47% and34.81% (χ^(2)=112.793, P<0.001) respectively;the differences were statistically significant.Conclusions The epidemic of drug-resistant tuberculosis is serious in Nanchong City. Especially,the rate of drug resistance and multidrug resistance in retreatment patients are extremely high. Drug resistance surveillance should be further strengthened to guide the rational use of clinical drugs and take targeted measures to prevent and control.