Drug Resistance Pattern in Pulmonary Tuberculosis Patients and Risk Factors Associated with Multi-Drug Resistant Tuberculosis

Introduction: Anti-tuberculosis drug resistance is a major problem in tuberculosis (TB) control programme, particularly multi-drug resistance TB (MDR-TB) in Nepal. Drug resistance is difficult to treat due to its associated cost and side effects. The objective of this study was to assess the drug resistance pattern and assess risk factor associated with MDR-TB among pulmonary tuberculosis patients attending National Tuberculosis Center. Methodology: The comparative cross sectional study was conducted at National Tuberculosis Center during August 2015 to February 2015. Early morning sputum samples were collected from pulmonary tuberculosis suspected patients and subjected to Ziehl-Neelsen staining and fluorochrome staining and culture on Lowenstein-Jensen (LJ) medium. Drug Susceptibility test was performed on culture positive isolates by using proportion method. Univariate and multivariate analysis was computed to assess the risk factors of MDR-TB. Results: Out of 223 sputum samples, 105 were fluorochrome staining positive, 85 were ZN staining positive and 102 were culture positive. Out of 102 culture positive isolates, 37.2% were resistance to any four anti-TB drugs. 11 (28.9%) were initial drug resistance and 28 (43.7%) were acquired drug resistance. The overall prevalence of MDR-TB was 11.7%, of which 2 (5.3%) were initial MDR-TB and 10 (15.6%) were acquired MDR-TB. Univariate and multivariate analysis showed female were significantly associated (P = 0.05) with MDR-TB. Conclusion: Drug resistance TB particularly MDR-TB is high. The most common resistance pattern observed in this study was resistance to both isoniazid and rifampicin. Female were found to be associated with MDR-TB. Thus, early diagnosis of TB and provision of culture and DST are crucial in order to combat the threat of DR-TB.

Clinical Study of Drug-resistant Pulmonary Tuberculosis Treated by Combination of Anti-Tuberculosis Chemicals and Compound Astragalus Capsule(复方黄芪胶囊)

Objective: To observe and evaluate the therapeutic effect of anti-tuberculosis (anti-TB) chemicals and Compound Astragalus Capsule (CAC) in combinedly treating drug resistant pulmonary tuberculosis (DR-TB). Methods: Ninety-two patients with DR-TB were equally randomized into the treated group (treated with combination therapy) and the control group (treated with anti-TB chemicals alone). The therapeutic course for both groups was 18 months. Therapeutic effects between the two groups were compared at the end of the therapeutic course. Sputum bacterial negative rate, focal absorption effective rate, cavity closing rate, 10-day symptom improving rate, the incidence of adverse reaction and 2-year bacteriological recurrence rate between the two groups were compared. Results: In the treated group, the sputum bacterial negative conversion rate was 84. 8% , focal absorption effective rate 91. 3% , cavity closing rate 58. 7% and 10-day symptom improving rate 54. 4% , while in the control group, the corresponding rates were 65.2% , 73. 9 % , 37.0% and 26.1 % , respectively. Comparison between the groups showed significant difference in all the parameters (P<0.05, P<0.05, P<0.05 and P<0.01). The incidence of adverse reaction and 2-year bacteriological recurrence rate in the treated group were 23. 9% and 2.6% respectively, while those in the control group 50. 0% and 16. 7% , which were higher than the former group with significant difference ( P<0. 01 and P<0. 05, respectively). Conclusion: The therapeutic effect of combined treatment with anti-TB and CAC is superior to that of treatment with anti-TB chemicals alone, and the Chinese herbal medicine showed an adverse reaction alleviating effect, which provides a new therapy for DR-TB, and therefore, it is worth spreading in clinical practice.

In Vitro Anti-tuberculosis Activity of Total Crude Extract of Echinops Amplexicaulis against Multi-drug Resistant Mycobacterium Tuberculosis

Background： TB （Tuberculosis） is the second leading killer infectious disease after HIV （human immunodeficiency virus）. Its incidence is worsened by development of multi-drag resistant and extensive drug resistant TB stxains. Available treatment regimens are expensive, toxic and lengtjy resulting to problems of non-adherence and inadequate response. Medicinal plants on the other hand may offer hope for developing alternative medicine for treatment of TB. This study evaluated the anti-tuberculosis activity of Echinops amplexicaulis. Materials and methods： Total crude extracts ofE. amplexicaulis were tested for activity against a wild strain resistant to Rifampicin and Isoniazid （MDR）, a fully susceptible laboratory strain （H37Rv） and Mycobacwrium boris （BCG strain） using disk diffusion method. MIC （minimum inhibitory concentration） was determined using Middlebrook 7H9 broil1. The strains were sub-cultured on Middlebrook 7H10 medium and MBC （minimum bactericidal concentration） determined. Susceptibility was evaluated by measuring zones of inhibition; MIC was obtained as the lowest concentration with no significant growth as shown by clog formation ofMTB （Mycobacwria tuberculosis） cells on the walls of the macro broth tube and MBC was obtained as the lowest concentration that inhibited growth of MTB colonies on Middlebrook 7H10 medium. Results： The extract showed a significant effect at a concentration of 50 mg/mL against all the three test strains F （2, 18） = 437.7, p = 0.00. It exhibited a MIC of 0.0488 mg/mL against MDR-TB and M. boris. Its MBC was the same at 0.0977 mg/mL against both MDR TB and M. boris. The MIC was much lower （0.0122 mg/mL） for the H37Rv strain. Terpenoids, alkaloids and tannins were present in large amount in the extract while saponins were present in small amounts. Flavonoids were not detected in the extract. Conclusion： E. amplexicaulis has the potential to be developed into new anti-TB drug and outcome of tile study supports the folkloric claims of anti-tuberculosis activity of tile plant.

Diabetes and tuberculosis:An emerging dual threat to healthcare

Tuberculosis(TB)remains a huge global healthcare challenge even in the 21^(st) century though the prevalence has dropped in developed countries in recent decades.Diabetes mellitus(DM)is an important risk factor for the development and perpetuation of TB owing to the immune dysfunction in patients with DM.The coexistence of both diseases in the same individual also aggravates disease severity,complications,and chance of treatment failure because of gross immune alterations posed by DM as well as TB.Various complex cellular and humoral immunological factors are involved in the dangerous interaction between TB and DM,some of which remain unknown even today.It is highly important to identify the risk factors for TB in patients with DM,and vice versa,to ensure early diagnosis and management to prevent complications from this ominous coexistence.In their research study published in the recent issue of the World Journal of Diabetes,Shi et al elaborate on the factors associated with the development of TB in a large cohort of DM patients from China.More such research output from different regions of the world is expected to improve our knowledge to fight the health devastation posed by TB in patients with diabetes.

Prevalence and Risk Factors of Primary Drug-Resistant Tuberculosis in China

Objective To investigate the prevalence of primary drug-resistant tuberculosis（TB） and associated risk factors in China. We also explored factors contributing to the transmission of multidrug-resistant tuberculosis（MDR-TB）. Methods A total of 2794 representative, Mycobacterium tuberculosis isolates from treatment-naive patients were subjected to drug susceptibility testing, and risk factors for drug-resistant TB were analyzed. We also analyzed MDR-TB strain sublineages, drug-resistance-conferring mutations, and risk factors associated with clustered primary MDR strains. Results Among 2794 Mycobacterium tuberculosis isolates from treatment-naive patients, the prevalence of any resistance to first-line drugs was 33.2% and the prevalence of MDR-TB was 5.7%. We did not find any risk factors significantly associated with resistance to first-line drugs. The 93 primary MDR-TB isolates were classified into six sublineages, of which, 75（80.6%） isolates were the RD105-deleted Beijing lineage. The largest sublineage included 65（69.9%） isolates with concurrent deletions of RD105, RD207, and RD181. Twenty-nine（31.2%） primary MDR strains grouped in clusters; MDR isolates in clusters were more likely to have S531 L rpoB mutation. Conclusion This study indicates that primary drug-resistant TB and MDR-TB strains are prevalent in China, and multiple measures should be taken to address drug-resistant TB.

An epidemiological study of resistant tuberculosis in Chongqing,China

Background The epidemiological characteristics of drug-resistant tuberculosis （DR-TB） is fundamental to improving the prevention and control of DR-TB. Mutations in katG315 is thought to be the most predictive molecule markers for Isoniazid （INH） resistance in Mycobacterium tuberculosis （MTB）. However, mutations to these genes have not been thoroughly studied in China, and epidemiological evidence of their expression levels are especially lacking in the southwest of China, which has a high TB burden within the population. Methods MTB isolates were obtained from patients with active pulmonary tuberculosis at the TB dispensary and Chest hospital in Chongqing city between June 2003 and June 2006. Proportion methods were used to test the sensitivity to INH, RFP, SM and EMB of cultured MTB. A total of 100 MTB isolates were also randomly selected for analysis of the molecular mutation spectrum of katG by DNA sequencing. Results Totally 1 089 MTB isolates that completed positive sputum cultures and evaluated for their sensitivity to the four first-line drugs among 2 777 patients with TB. The prevalence of DR-TB and multi-drug resistant tuberculosis （MDR-TB） were 27.7% （302/1 089） and 7.3% （79/1 089）, respectively. The resistance to anti-TB drugs was found to be highest for SM （16.3%） and INH （14.0%）. There was also a significant increase in the prevalence of resistance to RFP and EMB （P〈0.01）, and an increase in MDR-TB between June 2003 and June 2004 and between July 2005 and June 2006. The total mutation rate of katG315 was 75＂5% （37/49） in INH-resistant MTB, and mutation sites included $315T, $315N and $315I with mutation rates of 81.1% （30/37）, 13.5% （5/37） and 5.4% （2/37）, respectively No katG315 mutants were found in any of the 48 INH-sensitive MTB. Our preliminary diagnostic results suggest that mutations in katG315 may potentially serve as molecular markers that can be used to diagnose the resistance to anti-TB drug of INH. Conclusion In the Chongqing, DR-TB and MDR-TB are increasing, and are becoming key problems for tuberculosis control. The use of katG315 mutations as potential molecule markers for drug resistance to INH may help improve patient treatment and decrease the spread of the disease

Clinical efficacy and computed tomography diagnostic value of bedaquiline-containing regimens in the treatment of drug-resistant pulmonary tuberculosis

Objective:This study investigated the clinical efficacy of bedaquilinecontaining regimens in the treatment of drug-resistant pulmonary tuberculosis and the diagnostic value of computed tomography(CT).Methods:We retrospectively analyzed the clinical diagnosis,treatment,and CT imaging data of patients with drug-resistant pulmonary tuberculosis treated in Wenzhou Central Hospital from 1 January to 31 December 2022.According to whether the treatment regimen contained bedaquiline,the patients were divided into an observation group(bedaquiline tablets t background regimen)and a control group(background regimen).The clinical efficacy and pulmonary CT changes before and after treatment were analyzed in both groups.Results:After 24 weeks of treatment,there was no statistically significant difference in the white blood cell count or concentrations of hemoglobin,alanine aminotransferase,serum albumin,or creatinine between the two groups(t=0.71,0.93,0.05,0.18,and 0.08,respectively;p>0.05).After 4,8,and 12 weeks of treatment,there was no statistically significant difference in the sputum culture-negative conversion rate between the two groups(χ^(2)=2.67,0.48,and 1.82,respectively;p>0.05).At 24 weeks of treatment,the sputum culture-negative conversion rate in the observation group reached 100%,which was significantly higher than that in the control group(χ^(2)=3.97,p<0.05).The effective absorption rates on chest imaging in the two groups of patients at 12 weeks were 83.33% and 57.89%,respectively.At 24 weeks of treatment,the effective absorption rates were 88.00% and 65.85% in the two groups,with a statistically significant difference(χ^(2)=3.98;p<0.05).There were significant differences in cavity absorption at 24 weeks(χ^(2)=4.33,p<0.05)and 48 weeks after treatment(χ^(2)=10.63,p<0.05).Conclusion:The addition of bedaquiline to the background regimen improved the sputum culture-negative conversion rate and chest imaging effective rate.Patients achieved good results at the end of the 24-week treatment period.

Comparison of Two Molecular Assays For Detecting Smear Negative Pulmonary Tuberculosis

Objective To compare the performance of MTBDRplus V2 and Xpert MTB/RIF for detecting smear negative pulmonary tuberculosis （PTB）. Methods Clinical PTB suspects were enrolled consecutively in Anhui Chest Hospital and Xi＇an Chest Hospital from January to December in 2014. The sputum samples of smear negative PTB suspects were collected and decontaminated. The sediment was used to conduct MTBDRplus V2, Xpert MTB/RIF and drug susceptibility test （DST）. All the samples with discrepant drug susceptibility result between molecular methods and phenotypic method were confirmed by DNA sequencing. Results A total of 1973 cases were enrolled in this study. The detection rates of Mycobacterium tuberculosis complex （MTBC） by MTBDRplus V2 and Xpert MTB/RIF were 27.67% and 27.98%, respectively. When setting MGIT culture result as a gold standard, the sensitivity and specificity of MTBDRplus V2 were 86.74% and 93.84%, and the sensitivity and specificity of Xpert MTB/RIF were 86.55% and 93.43%, respectively. For the detection of the resistance to rifampin, the sensitivity and specificity of MTBDRplus V2 were 94.34% and 96.62%, and the sensitivity and specificity of Xpert MTB/RIF were 88.68% and 95.96%, respectively. For the detection of the resistance to isoniazid, the sensitivity and specificity of MTBDRplus V2 were 77.38% and 98.02%, respectively. Conclusion MTBDRplus V2 and Xpert MTB/RIF can be used to detect MTBC in smear negative samples with satisfactory performance.

Epidemiological characteristics of 369 tuberculosis patients with multidrug resistance inHainan Island: A cross-sectional study

Objective:To investigate the epidemic characteristics of multidrug resistant tuberculosis in Hainan,China,to provide basic information and theories for the prevention and control of multidrug resistant tuberculosis.Methods:A retrospective descriptive epidemiological study was conducted.Data of multidrug resistant tuberculosis in Hainan Island from January 1,2014 to December 31,2019 were collected for statistical analysis.The counting data were described by frequency(percentage),and the measurement data were described by mean±standard deviation.Chi square test was used to compare the differences between different groups.If P<0.05,the difference was statistically significant.Results:From 2014 to 2019,the multidrug resistant rate of tuberculosis in Hainan Island was 24.9%(369/1484),8.0%(63/791)in newly-treated tuberculosis,and 44.2%(306/693)in retreatedmultidrug resistant rate of tuberculosis in Hainan Island was 24.9%(369/1484),8.0%(63/791)in newly-treatedtuberculosis,and 44.2%(306/693)in retreated tuberculosis.The multidrug resistant rate of newly-treated tuberculosis decreased by 0.05%per year,while that of retreated tuberculosis increased by 0.03%per year.multidrug resistant tuberculosis was mainly distributed in the city of Haikou(83 cases),Danzhou(44 cases),Wenchang(42 cases),Wanning(37 cases)and Dongfang(32 cases),accounting for 64.5%of all multidrug resistant tuberculosis.Among 369 multidrug resistant tuberculosis,81.0%were male.The proportion of newly-treated cases was 17.1%(63/369),while the proportion of retreated cases was 82.9%(306/369),which was significantly higher than that of newly-treated cases.The multidrug resistant rate of tuberculosis in different years was different.Conclusion:The drug resistance rate of tuberculosis in Hainan Island is higher than the national average level,which needs attention.The epidemiological characteristics of multidrug resistant tuberculosis with different treatment history were different.

Rapid Molecular Detection of Tuberculosis and Rifampicine Resistance in Ecuador

Background: In Ecuador, tuberculosis (TB) remains a serious problem that is complicated by the emergence of multidrug-resistant TB (MDR-TB). To evaluate this problem, this study was carried out at the Social Security Hospital (IESS) in Guayaquil, Ecuador from 2013 to 2015. Methods: The Xpert TB/RIF system was used to detect TB and MDR-TB and a survey was carried out to identify the factors that are potentially causing MDR-TB. Findings: 200 TB patients were confirmed on 5649 suspected patients and 20 (10%) with MDR-TB. It was observed that the annual prevalence of TB and MDR-TB had declining during study period. Trends have been declining but co-infection has doubled since 2009 with 16% of patients co-infected with HIV. Potential resistance factors identified were: disruption in drug supply, lack of resources and lack of credibility of treatment.

The History of Tuberculosis: Past, Present, and Future

Tuberculosis (TB), transmitted by the bacteria Mycobacterium tuberculosis has been a global epidemic for years. The evidence for infection with TB is centuries old. It can have an indolent course, and may remain inactive for years in individuals with the possibility of reactivation at any time, causing widespread systemic symptoms. The treatment and management of TB has become more effective over the years. It is estimated that more than one-third of the world population, especially in poor and developing countries are harboring this bacterium with varying manifestations of the disease from no symptoms to life-threatening infections. This manuscript describes the history of the disease and the discoveries. It also includes the recent advances and challenges facing the world and how governments and organizations are working together to control this disease.

Anti TB drug resistance in Tanga,Tanzania:a cross sectional facility base prevalence among pulmonary TB patients

Objective:To determine the prevalence and risk factors associated with drug resistance tuberculosis(TB) at facility-base level in Tanga,Tanzania.Methods:A total of 79 Mycobacterium tuberculosis(MTB) isolates included in the study were collected from among372(312 new and 60 previously treated) TB suspects self referred to four TB clinics during a prospective study conducted from November 2012 to January 2013.Culture and drug susceptibility test of the isolates was performed at the institute of medical microbiology and epidemiology of infectious diseases,University hospital,Leipzig,Germany.Data on the patient's characteristics were obtained from structured questionnaire administered to the patients who gave informed verbal consent.Unadjusted bivariate logistic regression analysis was performed to assess the risk factors for drug resistant-TB.The significance level was determined at P<0.05.Results:The overall proportions of any drug resistance and MDRTB were 12.7%and 6.3%respectively.The prevalence of any drug resistance and MDRTB among new cases were 11.4%and 4.3%respectively,whereas among previously treated cases was 22.2%respectively.Previously treated patients were more likely to develop anti-TB drug resistance.There was no association between anti-TB drug resistances(including MDRTB) with the risk factors analysed.Conclusions:High proportions of anti TB drug resistance among new and previously treated cases observed in this study suggest that,additional efforts still need to be done in identifying individual cases at facility base level for improved TB control programmes and drug resistance survey should continuously be monitored in the country.

Tuberculosis treatment-new approach to an old problem

Chronic mycobacterium infections are major causes of disease burden of 20%in a tropical country like India. The inflammatory cascade following these bacterial infections often leads to tissue damage and perpetuates necrosis, fibrosis and the disease process.Pulmonary tuberculosis,multi-drug resistant tuberculosis not only affects individuals but society at large.Current remedial measures using various technology platforms singularly did not produce effective and appreciable reduction in global disease burden.On the contrary,the conventional chemotherapeutic chemical moieties have demonstrated variable pharmacogenomic expression,increased drug resistance,non compliance of strict prolonged drug regimens with debilitating side effects and contraindications. Furthermore,secreted inflammatory cytokines results in chronic infection,immune deviation,and immunopathology in the lungs.Hence,identification of immune escape mechanisms leading to chronic mycobacterial infections is crucial for development of new treatments.The review would dwell into the basic pathogenic mechanism and the newer approaches that may need to be considered for developing novel therapeutic strategies.

2015—2022年天水市肺结核患者耐药情况及利福平耐药特征分析

目的:分析2015—2022年甘肃省天水市肺结核患者耐药情况及利福平耐药特征,为优化耐药结核病卫生政策提供科学依据。方法:采用回顾性研究方法,从“中国疾病预防控制信息系统”子系统“结核病管理信息系统”中收集2015—2022年天水市肺结核患者实验室检测结果、耐药筛查和耐药结核病诊断信息等资料,分析患者病原学阳性率、药物敏感性试验结果和耐药诊断时间等。结果:2015—2022年,天水市共登记活动性肺结核患者8458例,除外结核性胸膜炎的肺结核患者为7895例,病原学阳性率为28.32%(2236/7895),且从2015年的11.33%(177/1562)上升至2022年的61.30%(236/385),呈明显上升趋势(χ_(趋势)^(2)=1014.480,P=0.000);天水市应耐药筛查肺结核患者2360例,实际耐药筛查率为85.00%(2006/2360),从2015年的54.80%(97/177)上升至2022年的93.39%(240/257),呈明显上升趋势(χ_(趋势)^(2)=397.292,P=0.000);天水市耐药检出率为98.90%(1984/2006),利福平耐药检出率为15.73%(312/1984),从2015年的10.42%(10/96)上升至2017年的28.57%(62/217),再下降至2022年的11.34%(27/238),呈先上升后下降趋势(χ_(趋势)^(2)=27.248,P=0.000)。312例利福平耐药患者中,男性[198例(63.46%)]多于女性[114例(36.54%)];年龄相对集中在20~29岁[85例(27.24%)]和40~49岁[66例(21.15%)],且老年患者(60~83岁)比例从2016年的9.52%(2/21)上升至2022年的25.93%(7/27),呈明显上升趋势(χ_(趋势)^(2)=4.801,P=0.028);职业以农民为主[213例(68.27%)];痰涂片结果以涂阳患者居多[215例(68.91%)],但痰涂片阳性率从2015年的100.00%(10/10)下降至2022年的59.26%(16/27),呈下降趋势(χ_(趋势)^(2)=17.664,P=0.000)。耐药谱前3位依次为利福平+异烟肼+乙胺丁醇[26.92%(84/312)]、利福平[26.28%(82/312)]和利福平+异烟肼[23.40%(73/312)]。耐药患者诊断时间中位数(四分位数)从2016年的145(91,196)d逐年下降至2019年的21(12,39)d。结论:2015—2022年天水市肺结核患者病原学阳性率和耐药筛查率均呈逐年上升趋势,利福平耐药检出率波动较大,耐药诊断时间明显缩短,建议加大老年肺结核患者利福平耐药筛查力度,以减少耐药肺结核的传播。

GeneXpert MTB/RIF检测技术在新疆结核病防治规划中的应用效果

目的:探索在施行结核病防治“新疆模式”中,全面应用GeneXpert MTB/RIF(简称“GeneXpert”)检测发现肺结核及利福平耐药肺结核的效果。方法:从“中国疾病预防控制信息系统”的子系统“结核病管理信息系统”中,收集2017—2020年新疆维吾尔自治区(简称“新疆”)肺结核登记数据,对全面应用GeneXpert检测的效果进行分析,评价2017-2020年肺结核病原学阳性率、利福平耐药检测率、利福平耐药患者发现水平的变化。结果:GeneXpert设备覆盖率、GeneXpert检测率、病原学阳性率分别从2017年的20.00%(22/110)、0.32%(126/39 261)和20.17%(7919/39 261)提高到2020年的100.00%(110/110)、75.16%(19 610/26 090)和57.94%(15 116/26 090),差异均有统计学意义(χ^(2)=40.705,P<0.001;χ^(2)=174.087,P<0.001;χ^(2)=47.569,P<0.001)。病原学阳性患者数从2017年的7919例提高到2020年的15 116例,仅GeneXpert检测阳性患者数从2017年的6例提高到2020年的7194例,所占比例从0.08%(6/7919)提高到47.59%(7194/15 116),差异有统计学意义(χ^(2)=83.824,P<0.001)。病原学阳性肺结核患者利福平耐药筛查率和GeneXpert耐药检测率分别从2017年的44.49%(3523/7919)和1.85%(65/3523)提高到2020年的99.79%(15 084/15 116)和96.13%(14 501/15 084),差异均有统计学意义(χ^(2)=133.333,P<0.001;χ^(2)=250.893,P<0.001)。结论:GeneXpert检测技术的应用,可以明显提升病原学阳性和利福平耐药肺结核的发现水平,有利于新疆结核病疫情的快速下降。

肺结核患者结核分枝杆菌耐药的影响因素

目的:分析肺结核患者结核分枝杆菌耐药的影响因素。方法:回顾性分析2020年4月至2023年4月于泉州市第一医院就诊的100例肺结核患者的临床资料,采集患者入院24 h内的晨痰行细菌培养和药敏试验,根据结核分枝杆菌是否耐药分为耐药组(n=40)和敏感组(n=60),分析结核分枝杆菌耐药的影响因素。结果:100例肺结核患者中结核分枝杆菌耐药40例,耐药率为40.00%,其中耐多药结核病占80.00%;两组性别、年龄、体质量指数、婚姻、病程、饮酒史、高血压、长期应用糖皮质激素、侵入性操作、病变累及肺叶数比较,差异均无统计学意义(P>0.05);两组居住地、吸烟史、糖尿病、空洞肺结核、复治肺结核情况比较,差异均有统计学意义(P<0.05);Logistic回归分析结果显示,居住农村、吸烟、合并糖尿病、空洞肺结核、复治肺结核均为肺结核患者结核分枝杆菌耐药的危险因素(OR>1,P<0.05)。结论:居住农村、吸烟、合并糖尿病、空洞肺结核、复治肺结核均为肺结核患者结核分枝杆菌耐药的危险因素。

青藏高原肺结核合并念珠菌感染患者的病原菌分布特点及耐药率分析

目的研究青藏高原肺结核患者中机会性念珠菌病原学分布特点及耐药情况。方法分析2020年3月1日至2020年12月31日青海省第四人民医院3012例住院肺结核患者,收集痰标本,采用VITEK-32-YBC全自动细菌分析系统进行念珠菌鉴定,并对检出的念珠菌进行药敏试验。结果在本次调查的3012例肺结核患者中,合并念珠菌感染的肺结核患者有283例,占9.40%。其中,念珠菌类型又以白念珠菌为主,占总数的79.86%。结论青藏高原地区肺结核合并念珠菌感染的患病率较高。因此,选择抗菌药物要根据患者的情况综合分析,以此来选择最佳、最有效的药物治疗方法。

2011—2020年北京市怀柔区耐药结核病高危人群利福平耐药筛查情况分析

目的:通过筛查耐药结核病高危人群,了解北京市怀柔区耐药结核病高危人群利福平耐药情况。方法:统计2011—2020年登记管理的肺结核患者中耐药结核病高危人群筛查情况,包括筛查对象、结核菌培养及药敏试验,对耐药高危人群利福平耐药情况进行分析。结果:2011—2020年北京市怀柔区共登记利福平耐药高危人群130例,完成耐药筛查130例,筛查率为100.00%。实验室污染率为3.08%,其中,涂阳培阴率为34.62%,主要体现在治疗2个月及以上的痰涂片或培养仍为阳性的初治患者中;耐药结核病高危人群培养阳性81例,菌种鉴定为结核分枝杆菌75例,检出利福平耐药23例,检出率为30.67%,明显高于与同期初治培养阳性的肺结核患者利福平耐药检率的3.33%,差异有统计学意义(χ^(2)=40.82,P<0.05)。结论:北京市怀柔区积极开展监测,使利福平耐药结核病能够得到有效的管理和医治,做到早发现、早治疗,避免因贫致病、因病返贫,更重要的是能够有效遏制利福平耐药肺结核的传播风险,减少对人们健康的危害。

肺结核继发其他病原菌肺部感染的病原菌特征及耐药性分析

目的分析肺结核继发其他病原菌肺部感染的病原菌特征及耐药性。方法2019年1月至2021年5月莆田学院附属医院收治的320例肺结核继发其他病原学肺部感染患者作为研究对象,取所有患者的痰液或肺泡灌洗液样本进行痰培养,并展开药敏试验。结果320例患者共分离96株病原菌,病原菌分布为革兰阴性菌占比58.33%、真菌占比28.13%和革兰阳性菌占比13.54%。革兰阳性菌以金黄色葡萄球菌和表皮葡萄球菌最常见,对哌拉西林、庆大霉素、左氧氟沙星的耐药性最高,对多粘菌素B、美罗培南和亚胺培南的耐药性低;革兰阴性菌以肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌和大肠埃希菌最常见,对青霉素、苯唑西林、红霉素的耐药性最高,对万古霉素、利奈唑胺和替加环素的耐药性低;真菌以白假丝孝母菌最常见,对酮康唑、氟康唑的耐药性最高,对两性霉素和伏立康唑的耐药性低。结论导致肺结核继发肺部感染的病原菌种类多,需开展病原学检查,并以药敏试验结果为参考合理的选择药物,以确保临床治疗有效性及用药安全性。

耐多药肺结核病患者生命质量及影响因素分析

目的探讨耐多药和利福平耐药肺结核病(multidrug-resistant and rifampin-resistant pulmonary tuberculosis,MDR/RR-PTB)患者的健康相关生命质量(health related quality of life,HRQOL)并分析其影响因素。方法选取2021年至2024年巴中市《结核病管理信息系统》登记治疗管理的50例MDR/RR-PTB患者为耐药组,选取同期该系统登记治疗管理的对抗结核药物治疗敏感的肺结核患者50例作为对照组,采用慢性肺结核患者生命质量测定量表(quality of life instuments for chronic disease pulmonary tuberculosis,QLICD-PT)评估并比较两组患者的HRQOL,用多重线性回归分析法分析影响MDR/RR-PTB患者HRQOL的因素。结果与对照组比较,MDR/RR-PTB组患者除生理功能得分外,其他各模块差异均有统计学意义(P<0.05)。单因素分析结果显示,不同性别、医保类别、家庭月收入、有无合并症、淋巴细胞计数、白蛋白、C反应蛋白、体质量指数的患者QLICD-PT总分差异有统计学意义(P<0.05)。多重线性回归分析结果显示,医保类别、家庭月收入差异有统计学意义(P<0.05)。结论MDR/RR-PTB患者HRQOL低于对抗结核药物敏感的肺结核患者,患者的医保类别、家庭月收入是MDR/RR-PTB患者HRQOL的可能影响因素。