番禺地区结核分枝杆菌耐药状况及耐药谱分析
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摘要
目的探析番禺地区结核分枝杆菌的耐药情况与耐药谱。方法选择2011年2月至2014年2月期间番禺地区就诊的结核病患者1 033例,并对其分离株进行菌种鉴定。检测其对利福平(RIF)、异烟肼(INH)、链霉素(SM)及乙胺丁醇(EMB)的耐药性。并进一步分析对INH耐药的结核分枝杆菌的耐药谱分布情况。结果 1 033株结核菌株中,总耐药率为42.01%(434/1 033),其中,初始患者耐药率低于复治患者(40.32%比48.20%),两者耐药率具有统计学差异(χ2=4.440,P=0.035)。男性患者耐药率低于女性患者(37.18%比57.55%),两者耐药率具有统计学差异(χ2=31.826,P<0.01)。30~60岁年龄段患者耐药率最高,<30岁、30~60岁和>60岁3个年龄段耐药率(28.78%比48.31%比27.68%)比较差异有统计学意义(χ2=48.852,P<0.01)。所检测的RIF、INH、SM及EMB耐药顺序为INH(14.98%)>RIF(13.36%)>SM(9.11%)>EMB(4.56%)。155株INH耐药株中,同时耐RIF的有46(29.68%)株,耐多药率为4.45%(46/1 033)。结论番禺地区结核分枝杆菌的耐药情况较严重,与患者年龄、性别等有关,应加强对耐药杆菌的检测,采取有效的防控措施。
Objective To investigate drug- resistant situation and antibiogram of Mycobacterium tuberculosis( M. tuberculosis) in Fanyu. Methods During the time of February 2011 to February 2014,1 033 tuberculosis patients were selected and the isolates obtained from the patients were identified. The resistance of these isolates to rifampicin,isoniazid,streptomycin and ethambutol were tested and the antibiogram were analyzed. Results The total drug- resistance rate of M. tuberculosis isolates was 42. 01 %( 434 /1 033). The initial drug- resistance rate( 40. 32 %) was lower than acquired drug- resistance rate( 48. 20 %),the difference was statistically significant( χ2= 4. 440,P =0. 035). The drug- resistance rate in male( 37. 18 %) was lower than in female( 57. 55 %)( χ2= 31. 826,P < 0. 01). The patients between 30 and 60 years of age had highest resistance rate( 48. 31 %) than other age groups( χ2= 48. 852,P = 0. 01). The resistance rates to isoniazid,rifampicin,streptomycin and ethambutol were 14. 98 %,13. 36 %,9. 11 % and 4. 56 %,respectively. Of the 155 isoniazid- resistant isolates,46( 29. 68 %) were also resistant to rifampicin and the multi- drug resistance rate was 4. 45 %( 46 /1 033). Conclusion The drug resistance of M. tuberculosis in Fanyu was serious and we need to strengthen the detection of drug- resistant tuberculosis,and take effective prevention and control measures.
Objective To investigate drug- resistant situation and antibiogram of Mycobacterium tuberculosis( M. tuberculosis) in Fanyu. Methods During the time of February 2011 to February 2014,1 033 tuberculosis patients were selected and the isolates obtained from the patients were identified. The resistance of these isolates to rifampicin,isoniazid,streptomycin and ethambutol were tested and the antibiogram were analyzed. Results The total drug- resistance rate of M. tuberculosis isolates was 42. 01 %( 434 /1 033). The initial drug- resistance rate( 40. 32 %) was lower than acquired drug- resistance rate( 48. 20 %),the difference was statistically significant( χ2= 4. 440,P =0. 035). The drug- resistance rate in male( 37. 18 %) was lower than in female( 57. 55 %)( χ2= 31. 826,P < 0. 01). The patients between 30 and 60 years of age had highest resistance rate( 48. 31 %) than other age groups( χ2= 48. 852,P = 0. 01). The resistance rates to isoniazid,rifampicin,streptomycin and ethambutol were 14. 98 %,13. 36 %,9. 11 % and 4. 56 %,respectively. Of the 155 isoniazid- resistant isolates,46( 29. 68 %) were also resistant to rifampicin and the multi- drug resistance rate was 4. 45 %( 46 /1 033). Conclusion The drug resistance of M. tuberculosis in Fanyu was serious and we need to strengthen the detection of drug- resistant tuberculosis,and take effective prevention and control measures.
引文
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[14]Lakshmi PV,Virdi NK,Thakur JS,et al.Biomassfuel and risk of tuberculosis:a case-control study from Northern India[J].J Epidemiol Community Health,2012,66(5):457-461.
[15]Dumonceaux GA,St Leger J,Olsen JH,et al.Genitourinary and pulmonary multidrug resistant Mycobacterium tuberculosis infection in an Asian elephant(Elephas maximus)[J].J Zoo Wildl Med,2011,42(4):709-712.
[2]Bao JR,Master RN,Schwab DA,et al.Identification of acid‐fast bacilli using py rosequencing analysis[J].Diagn Microbiol Infect Dis,2010,67(3):234-238.
[3]梁冰,黎意芬,黄瑞霞,等.耐药结核病人的耐药状况分析[J].临床肺科杂志,2011,16(6):891-892.
[4]钟球,尹建军,钱明,等.广东省结核病耐药性基线调查研究[J].中国防痨杂志,2011,33(7):393-399.
[5]颜京瑞.检测结核抗体对结核病的临床诊断价值[J].检验医学与临床,2010,7(2):113-115.
[6]Karolemeas K,Mc Kinley TJ,Clifton-Hadley RS,et al.Recurrence of bovine tuberculosis breakdowns in Great Britain:riskfactors andprediction[J].Prev Vet Med,2011,102(1):22-29.
[7]Lai CC,Liu WL,Tan CK,et al.Differences in drug resistance profiles of Mycobacterium tuberculosis isolates causing pulmonary and extrapulmonary tuberculosis in a medical centre in Taiwan,2000-2010[J].Int J Antimicrob Agents,2011,38(2):125-129.
[8]Mitchell SL,Seoudi N,Hutchison DC,et al.Multidrug-resistant tuberculosis:resistance rates to first and reserve antituberculosis drugs in the UK in 2008/9 and the role of rapid molecular tests for drug resistance[J].Thorax,2011,66(7):630-631.
[9]朱士玉,后永春,舒文,等.中国四省市结核病发病危险因素研究[J].中华流行病学杂志,2013,34(2):129-132.
[10]吴映娥,彭文光,郑高哲.潮汕地区结核分枝杆菌耐药性及耐药谱分析[J].中国校医,2014,28(4):263-265.
[11]陈建,杨光京,罗槑,等.四川地区结核分枝杆菌耐药性和耐药谱分析[J].现代预防医学,2010,37(17):3211-3212.
[12]Blakemore R,Story E,Helb D,et al.Evaluation of the analytical performance of the Xpert MTB/RIF assay[J].J Clin Microbiol,2010,48(7):2495-2501.
[13]Mironova S,Pimkina E,Kontsevaya I,et al.Performance of the GenoType MTBDRPlus assay in routine settings:amulticenter study[J].Eur J Microbiol Infect Dis,2012,31(7):1381-1387.
[14]Lakshmi PV,Virdi NK,Thakur JS,et al.Biomassfuel and risk of tuberculosis:a case-control study from Northern India[J].J Epidemiol Community Health,2012,66(5):457-461.
[15]Dumonceaux GA,St Leger J,Olsen JH,et al.Genitourinary and pulmonary multidrug resistant Mycobacterium tuberculosis infection in an Asian elephant(Elephas maximus)[J].J Zoo Wildl Med,2011,42(4):709-712.