2021年河南省1277株结核分枝杆菌耐药特征分析

Drug resistance characteristics of 1 277 isolates of Mycobacterium tuberculosis in Henan province in 2021

目的 了解河南省结核分枝杆菌耐药特征,为结核病临床治疗和防控提供数据支持。方法 收集2021年河南省30个县(市、区)初诊涂阳肺结核患者分离鉴定的结核分枝杆菌,采用结核分枝杆菌比例法固体药敏试验法,开展对异烟肼(INH)、利福平(RFP)、链霉素(SM)、乙胺丁醇(EMB)、氧氟沙星(OFX)、左氧氟沙星(LFX)、卡那霉素(KM)、莫西沙星(MFX)、阿米卡星(AM)9种抗结核药物的敏感性试验并分析耐药性。结果 共获得结核分枝杆菌1 277株,总耐药率23.88%(305株)、单耐药率11.35%(145株)、耐多药率5.17%(66株)、多耐药率7.36%(94株)、准广泛耐药率0.47%(6株)、广泛耐药率0.31%(4株);结核分枝杆菌耐一线药物最高为SM(14.72%,188株)、其次为INH(12.53%,160株),耐二线药物最高为OFX(5.4%,69株)、其次为LFX(4.23%,54株);从初治肺结核患者分离结核分枝杆菌对9种药物的耐药率均低于复治患者(P均<0.05)。66株耐多药结核分枝杆菌的耐药谱中占比最高的前3种是RFP+INH+SM(12.12%,8株)、RFP+INH+EMB+SM(27.27%,18株)和RFP+INH+EMB+SM+OFX+LFX+MFX(21.21%,14株);SM与AM(KM)存在单向交叉耐药,AM与KM存在低度双向交叉耐药情况,MFX、LFX与OFX存在相互交叉耐药情况。结论 河南省结核分枝杆菌总耐药、耐多药以及喹诺酮类药物的耐药情况仍较为严重,应积极采取措施以降低耐药率及减少耐药结核病的传播。

Objective To understand the drug resistance characteristics of Mycobacterium tuberculosis in Henan province, and provide data support for the clinical treatment and prevention of tuberculosis. Methods Mycobacterium tuberculosis(M.tuberculosis) isolates from newly diagnosed smear-positive pulmonary tuberculosis patients in 30 counties(cities and districts)of Henan province in 2021 were collected. Drug susceptibility tests on 9 anti-tuberculosis drug [Isoniazid(INH), Rifampicin(RFP), Streptomycin(SM), Ethambutol(EMB), Ofloxacin(OFX), Kanamycin(KM), Moxifloxacin(MFX), Levofloxacin(LFX),Amikacin(AM)] were conducted using the proportion method based on the solid medium, and the drug resistance was analyzed.Results A total of 1 277 isolates of M. tuberculosis were collected, with an overall drug resistance rate of 23.88%(305/1 277),single drug resistance rate of 11.35%(145/1 277), multi-drug resistance rate of 5.17%(66/1 277), poly-drug resistance rate of7.36%(94/1 277), pre-extensive resistance rate of 0.47%(6/1 277) and extensive resistance rate of 0.31%(4/1 277). The highest resistant rate of M. tuberculosis to first-line drugs was SM(14.72%, 188/1 277), followed by INH(12.53%, 160/1 277);the highest resistant rate of M. tuberculosis to second-line drugs was OFX(5.4%, 69/1 277), followed by LFX(4.23%, 54/1 277).M. tuberculosis isolates from initially-treated tuberculosis patients had lower resistant rate to the nine drugs tested than those from retreated patients(all P<0.05). Of the 66 multidrug-resistant isolates, the top three patterns with the highest proportions were RFP +INH +SM(12.12%, 8/66), RFP +INH +EMB +SM(27.27%, 18/66) and RFP +INH +EMB +SM +OFX +LFX +MFX(21.21%, 14/66). There was single-directional cross-resistance between SM and AM(KM), and bidirectional cross-resistance at low concentration between AM and KM, and mutual cross-resistance between MFX, LFX and OFX. Conclusions The overall drug resistance, multidrug resistance and quinolone drug resistance of Mycobacterium tuberculosis in Henan province are still relatively serious, and active measures should be taken to reduce the drug resistance rate and the spread of drug-resistant tuberculosis.