嘉兴市结核分枝杆菌耐药情况分析

Drug resistance surveillance in Mycobacterium tuberculosis in Jiaxing City

目的了解2017—2019年浙江省嘉兴市结核分枝杆菌对一线抗结核药物的耐药情况,为提高肺结核治疗效果提供依据。方法通过中国疾病预防控制信息系统结核病管理信息系统,收集2017—2019年嘉兴市1310例肺结核患者监测资料,包括人口学信息、治疗分类、痰培养和药敏检测结果等,采用描述性流行病学方法分析结核分枝杆菌对异烟肼(INH)、利福平(RFP)、链霉素(SM)和乙胺丁醇(EMB)的耐药谱、耐药率和耐药类型。结果2017—2019年嘉兴市分离出结核分枝杆菌1310株,对至少1种抗结核药物耐药259株,耐药率为19.77%;INH、SM、RFP和EMB耐药率分别为13.36%、11.83%、5.50%和3.59%。复治患者分离株耐药率为34.58%,高于初治患者的18.45%(P<0.05)。耐1种药以SM和INH耐药率较高,分别为4.50%和4.35%;耐2种药组合中以INH+SM耐药率较高,为3.28%;耐3种药组合以INH+RFP+SM耐药率较高,为1.83%;耐4种药有16株,耐药率为1.22%。单耐药率、RFP耐药率、多耐药率和耐多药率分别为10.31%、5.50%、4.73%和4.73%。2017—2019年全部患者和初治患者RFP耐药率呈逐年上升趋势(P<0.05)。省间流动患者分离株RFP耐药率和耐多药率分别为7.01%和6.01%,均高于本地非流动患者的3.76%和3.25%(P<0.05)。结论2017—2019年嘉兴市结核分枝杆菌耐药率低于浙江省水平,主要为INH和RFP耐药。

Objective To investigate the resistance of Mycobacterium tuberculosis to first-line anti-tuberculosis drugs in Jiaxing City,Zhejiang Province from 2017 to 2019,so as to provide insights into improvements of the therapeutic effect of pulmonary tuberculosis.Methods Data pertaining to pulmonary tuberculosis in Jiaxing City from 2017 to 2019 were collected from the Tuberculosis Surveillance System of Chinese Disease Prevention and Control Information System,including demographics,treatment classification,sputum culture and drug resistance.The spectrum,types and prevalence of drug resistance in M.tuberculosis to four first-line tuberculosis drugs,including isoniazid(INH),rifampicin(RFP),streptomycin(SM)and ethambutol(EMB),was analyzed using a descriptive epidemiological method.Results A total of 1310 M.tuberculosis isolates were cultured from pulmonary tuberculosis patients in Jiaxing City from 2017 to 2019,and there were 259 M.tuberculosis isolates that were resistant to anti-tuberculosis drugs,with an overall drug resistance rate of 19.77%.The prevalence rates of drug resistance to INH,SM,RFP and EMB were 13.36%,11.83%,5.50%and 3.59%,respectively.The prevalence of drug resistance was lower in M.tuberculosis isolates from treatment-naïve patients than from retreated patients(18.45%vs.34.58%,P<0.05).M.tuberculosis isolates presented high resistance to SM(4.50%)and INH alone(4.35%),the highest resistance to INH-SM combinations(3.28%),and the highest resistance to INH+RFP+SM combinations(1.83%).Sixteen isolates were resistant to all the four drugs,with a drug resistance rate of 1.22%.The proportions of resistance to a single drug,RFP resistance,multidrug resistance and resistance to two and more drugs were 10.31%,5.50%,4.73%and 4.73%,respectively.In addition,the prevalence of RFP resistance among all patients and treatment-naïve patients both showed a tendency towards a rise from 2017 to 2019(P<0.05).The prevalence of RFP resistance(7.01%vs.3.76%)and resistance to two and more drugs(6.01%vs.3.25%)was both higher among interprovincial mobile tuberculosis patients than among local non-mobile patients(P<0.05).Conclusions The overall prevalence of drug resistance was lower in M.tuberculosis isolates in Jiaxing City from 2017 to 2019 than in Zhejiang Province,with INH and RFP resistance as predominant types.