2006-2017年天津市结核分枝杆菌耐药性分析

Analysis of drug resistance of Mycobacterium tuberculosis during 2006-2017 in Tianjin

目的回顾性分析12年间天津市结核分枝杆菌对4种一线抗结核药物和部分二线抗结核药物的耐药性,为结核病的诊治工作提供参考。方法选择2006年1月-2017年12月于医院就诊的结核病患者77 739例分离的结核分枝杆菌共20 212株,追踪其4种一线抗结核药物[异烟肼(H)、利福平(R)、乙胺丁醇(E)、链霉素(S)]及部分二线抗结核药物[氨基水杨酸(PAS)、丁胺卡那霉素(AK)、左氧氟沙星(V)、氧氟沙星(O)、卷曲霉素(Cm)、卡那霉素(Km)、环丙沙星、丙硫异烟胺(Pto)]的耐药结果,并分析其耐药性变化。结果 2006-2017年共检出结核分枝杆菌20 212株,单耐药、多耐药、耐多药分别占13.68%(2 765/20 212)、8.80%(1 778/20 212)、12.29%(2 484/20 212)。2013-2017年泛耐药共计74株,占同期总菌株数的0.53%(74/14 092)。2006-2017各年间总体耐药率在31.00%～40.89%;12年间快培阳性结核分枝杆菌15 118株,耐单药次序为H>S>R>E;2013-2017年5年间慢培阳性结核分枝杆菌5 094株,耐药顺序为S>H>R>E>PAS,氧氟沙星耐药菌株占同期总菌株数的15.92%(690/4 334),卷曲霉素1.76%(73/4 155)。结论 12年间总耐药率呈逐渐下降趋势,但近两年有所回升;耐多药率偏高,广泛耐药率控制在较低水平。12年间结核分枝杆菌对S、H、R、E四种一线抗结核药物耐药率在2008年达到最低点,近三年较前有所回升。

OBJECTIVE To retrospectively analyze the resistance of Mycobacterium tuberculosis to 4 kinds of firstline and some kinds of second-line anti-TB drugs during 2006-2017 in Tianjin,and to provide scientific reference for diagnosis and treatment of tuberculosis.METHODS A total of 20 212 strains isolated from 77739 tuberculosis patients treated in the hospital during Jan.2006 to Dec.2017 were selected,then the drug susceptibility test results for 4 kinds of first-line[isoniazid(H),rifampicin(R),ethambutol(E),streptomycin(S)]and some kinds of second-line anti-TB drugs [including aminosalicylate(PAS),amikacin(AK),levofloxacin(V),ofloxacin(O),capreomycin(Cm),kanamycin(Km),ciprofloxacin and protionamid(Pto)]were traced,and the change in drug resistance was analyzed.RESULTS A total of 20 212 strains of M tuberculosis were detected from 2006-2017,the mono-resistant rate,poly-resistant rate and multidrug-resistant rate were 13.68%,8.80%and 12.29%,respectively.There were 74 strains of extensively drug-resistant M tuberculosis strains from 2013 to 2017,accounting for 1.50% of the total strains in the same period.The total drug-resistance rate from 2006 to 2017 was between 31.00% and 40.89%.There were 15118 strains cultured positive by using BACTEC MGIT960-TB liquid culture method from 2006 to 2017,and the order of drug resistance was H>S>R>E.There were 5 094 strains cultured positive by using modified Roche medium culture method from 2013 to 2017,and the order of drug resistance was S>H>R>E>PAS.The resistance rate to ofloxacin and capreomycin was 15.92%(690/4 334)and1.76%(73/4 155)respectively.CONCLUSIONSince 2006,the overall drug resistance rate has gradually declined,but it has recovered in the past two years.The drug resistance rate was high,but the extensively drug-resistant rate was controlled at a lower level.The drug resistance rates to S,H,R,E reached the lowest point in 2008 and have rebounded in the past three years.