2016年—2021年南阳市6787株结核分枝杆菌耐药特征及其分析

Drug resistance and analysis of 6787 Mycobacterium tuberculosis strains in Nanyang City during 2016-2021

目的 分析南阳市结核分枝杆菌对一线和部分二线抗结核药物的耐药情况,为本地区结核病的诊断、治疗以及预防工作提供参考和科学依据。方法 共选择分析2016年—2021年于南阳六院就诊的肺结核患者培养阳性菌株,采用比例法进行菌种分型以及药物敏感性试验,监测对链霉素、异烟肼、利福平、乙胺丁醇、氧氟沙星、阿米卡星等6种抗结核药物的耐药性。结果 共培养结核分枝杆菌6 787例,非结核分枝杆菌(NTM)604例,总耐药率为18.9%,广泛耐药率为1.2%,初始耐药率为17.2%,获得性耐药率为41.7%。耐多药率为7.2%,初治耐多药率为4.9%,获得性耐多药率为39.4%,6种抗结核药物的耐药率由高到低分别为链霉素(11.9%)、异烟肼(8.9%)、利福平(8.6%)、氧氟沙星(6.1%)、乙胺丁醇(5.8%)、卡那霉素(1.3%)。结论 南阳六院分离出的结核分枝杆菌耐多药率和二线药物耐药率均偏高,尤其是复治患者,南阳市区及各辖县应加强结核病患者登记治疗管理工作,合理使用二线药物。

Objective To retrospectively analyze the resistance ofMycobacterium tuberculosisto first-line and some second-line anti-tuberculosis drugs in Nanyang City,Henan Province,so as to provide reference and scientific basis for the diagnosis,treatment and prevention of tuberculosis in this region.Methods Positive strains cultured from tuberculosis patients of Nanyang Sixth People.s Hospital between 2016 and 2021 were selected as test samples.The identification test and drug susceptibility test of those strains were carried out based on the scaling method,which aimed to investigate their resistance to six anti-tuberculosis drugs including streptomycin(S),isoniazid(H),rifampicin(R),ethambutol(E),ofloxacin(O) and amikacin(K).Results A total of 6 787 strains ofMycobacterium tuberculosisand 604 strains of nontuberculosis mycobacteria were cultured.The total drug resistance rate was 18.9%,the extensively drug resistance rate was 1.2%,the initial drug resistance rate was17.2%,and the acquired drug resistance rate was 41.7%.The multi-drug resistance rate was 7.2%,the initial multi-drug resistance rate was 4.9%,and the acquired multi-drug resistance rate was 39.4%.The drug resistance rate of the six anti-tuberculosis drugs ranged from high to low:streptomycin(S)(11.9%),isoniazid(H)(8.9%),rifampicin(R)(8.6%),ofloxacin(O)(6.1%),ethambutanol(E)(5.8%),kanamycin(K)(1.3%).Conclusion The multi-drug resistance rate and second-line drugs resistance rate ofMycobacterium tuberculosisare relatively high among tuberculosis patients of Nanyang Sixth People.s Hospital,particularly among those who had retreatment.Therefore,it is necessary to strengthen the treatment and management of tuberculosis patients and the clinical rational use of second-line drugs in Nanyang City.