2020年云南省肺结核病例耐药监测分析

Surveillance on drug resistance of Mycobacterium tuberculosis strains in Yunnan province in 2020

目的分析2020年云南省肺结核病例结核分枝杆菌耐药情况。方法对2020年云南省32个监测点涂阳肺结核病例标本进行培养、初步菌型鉴定和药敏试验,分析耐药情况。结果共成功分离培养分枝杆菌1175株,其中非结核分枝杆菌27株(2.30%,27/1175),剩余的1148株结核分枝杆菌任一耐药率为14.81%(95%CI:12.75%~16.87%),耐多药率为4.88%(95%CI:3.63%~6.13%),准广泛耐药率为1.31%(95%CI:0.65%~1.96%)。异烟肼耐药率为11.32%,利福平耐药率为5.31%,左氧氟沙星耐药率为4.44%,莫西沙星耐药率为4.44%,阿米卡星耐药率为0.35%,耐药率顺位为:异烟肼>利福平>左氧氟沙星=莫西沙星>阿米卡星。初治患者和复治患者异烟肼耐药率分别为9.51%和25.78%(χ^(2)=29.986,P<0.01)、利福平耐药率分别为3.73%和17.47%(χ^(2)=45.858,P<0.01)、氟喹诺酮类药物耐药率分别为3.63%和12.50%(χ^(2)=20.331,P<0.01)、任一耐药率分别为12.55%和32.81%(χ^(2)=37.016,P<0.01)、耐多药率分别为3.43%和16.41%(χ^(2)=41.262,P<0.01)。结论近年来分子生物学诊断技术在云南的广泛使用,云南省耐药肺结核的疫情得到了一定程度的控制,但防控形势依然严峻,特别是氟喹诺酮类药物耐药率还出现了升高。需要持续重视耐药肺结核患者的发现、治疗和管理,并严格控制氟喹诺酮类药物在结核病患者治疗中的使用。

Objective To understand the drug resistance of Mycobacterium tuberculosis strains isolated from pulmonary tuberculosis patients in Yunnan province in 2020.Methods Samples collected from smear-positive TB cases at 32 monitoring sites in Yunnan in 2020 were cultured to isolate bacterial strains.Meanwhile bacterial identification and drug sensitivity test were performed.Results A total of 1175 mycobacteria strains were successfully isolated,of which 27 were non-tuberculous mycobacteria(2.30%).The resistance rate to single drug of the remaining 1148 mycobacteria strains was 14.81%(95%CI:12.75%-16.87%),and the multidrug-resistant rate was 4.88%(95%CI:3.63%-6.13%),and the extensively drug resistant rate was 1.31%(95%CI:0.65%-1.96%).Drug resistance rates to isoniazid rifampicin,levofloxacin,moxifloxacin and amikacin were 11.32%,5.31%,4.44%,4.44%and 0.35%.Among the 170 drug-resistant strains,71 were only resistant to isoniazid(including 59 strains from newly-treated patients and 12 strains from re-treated patients),and among 61 RFP-resistant strains,16 strains were also resistant to fluoroquinolones(levofloxacin/moxifloxacin).There were significant differences in resistance rate to isoniazid(χ^(2)=29.986,P<0.01),to rifampicin(χ^(2)=45.858,P<0.01),to fluoroquinolone(χ^(2)=20.331,P<0.01),to any drug(χ^(2)=37.016,P<0.01),and to multidrug(χ^(2)=41.262,P<0.01)between newly treated patients and retreated patients.Conclusions Due to the wide use of RFP-resistant molecular biology diagnostic technology in Yunnan in recent years,the epidemic of drug-resistant tuberculosis in Yunnan province has been controlled to a certain degree.However,the resistance rate to fluoroquinolones has increased.Therefore,we still need to strengthen the detection,treatment and management of drug-resistant tuberculosis,and control the use of fluoroquinolones in the treatment of tuberculosis patients.