西安市新定义广泛耐药结核病的发生分析

Prevalence of new defined extensive drug resistant tuberculosis in Xi'an

目的收集西安市2019—2020年经表型药敏检出的耐多药结核病结核分枝杆菌,分析耐多药结核分枝杆菌对二线抗结核药物的耐药及新定义广泛耐药结核病的发生情况,为耐多药结核患者的方案制定提供依据。方法选取2019—2020年西安市胸科医院进行表型药物敏感性试验的结核分枝杆菌3088株为对象,回顾性分析各抗结核药物耐药情况。从保存的耐多药结核分枝杆菌中随机选取114株,采用比例法进行贝达喹啉和利奈唑胺药物敏感性试验,结合既往药物敏感性检测结果分析新定义广泛耐药发生情况。结果在3088株结核分枝杆菌中,检出异烟肼耐药411株(占14.3%),利福平耐药347株(占11.2%),乙胺丁醇耐药142株(占4.6%),链霉素耐药550株(占17.8),耐多药237株(占7.6%)。237株耐多药结核分枝杆菌对乙胺丁醇、莫西沙星、左氧氟沙星、对氨基水杨酸钠、丙硫异烟胺、卷曲霉素、阿米卡星、氯法齐明耐药率分别为44.3%、26.6%、33.3%、24.1%、5.1%、4.2%、3.0%、2.5%。114株随机选取的耐多药结核分枝杆菌中检出贝达喹啉耐药0株,利奈唑胺耐药3株,新定义广泛耐药结核1株。结论西安市耐多药结核分枝杆菌对乙胺丁醇、喹诺酮及对氨基水杨酸钠耐药率较高,用药时应尽量获得其药物敏感性试验结果;新定义广泛耐药结核发生率低,即使无药物敏感性检测结果贝达喹啉和利奈唑胺仍是治疗耐多药结核的有效药物。

Objective To collect extensively drug-resistant tuberculosis(XDR-TB)Mycobacterium tuberculosis strains isolated from Xi'an City between 2019 and 2020,and analyze the drug resistance patterns of XDR-TB strains to second-line anti-tuberculosis drugs and the occurrence of new defined extensively drug-resistant tuberculosis in Xi'an,in order to provide evidence for guiding clinical drug use of multidrug-resistant tuberculosis(MDR-TB)patients.Methods A total of 3088 strains of Mycobacterium tuberculosis that underwent phenotypic drug susceptibility testing at Xi'an Chest Hospital from January 2019 to December 2020 were retrospectively selected to analyze the resistance of anti-tuberculosis drug.Among the stored MDR-TB strains,114 strains of preserved multidrug-resistant Mycobacterium tuberculosis were randomly selected for bedaquiline and linezolid susceptibility testing.Combined with the results of previous second-line drug susceptibility testing,the incidence of newly defined extensive drug resistance was analyzed.Results Among the 3088 Mycobacterium tuberculosis strains analyzed,411 strains(14.3%)showed resistance to isoniazid,347 strains(11.2%)showed resistance to rifampicin,142 strains(4.6%)showed resistance to ethambutol,550 strains(17.8%)showed resistance to streptomycin,and 237 strains(7.6%)exhibited multidrug resistance.Of 237 MDR-TB strains,the resistance rates of ethambutol,moxifloxacin,rifampicin,sodium para-aminosalicylate,prothioconazole,capreomycin,amikacin,and clofazimine were 44.3%,26.6%,33.3%,24.1%,5.1%,4.2%,3.0%,and 2.5%,respectively.Among the randomly selected 114 MDR-TB strains,none showed resistance to bedaquiline,three showed resistance to linezolid,and one strain met the new definition for extensively drug-resistant tuberculosis.Conclusion In Xi'an City,high rates of resistance among MDR-TB strains are observed for ethambutol,quinolone and sodium para-aminosalicylate,and the drug susceptibility tests should be obtained as much as possible when using these drugs.The incidence of new definition extensively drug-resistant tuberculosis is low,and bedaquiline and linezolid remain effective drugs for the treatment of multidrug-resistant tuberculosis even without drug susceptibility testing results.