Objective To analyze drug-resistance of tuberculosis and nontuberculous mycobacteria in Zhuhai, in order to provide basis data for disease treatment, prevention and control.
Methods A retrospective analysis of culture-positive cases of tuberculosis and nontuberculous mycobacteria was conducted in hospital from January 2014 to June 2018. After species identification , drug susceptibility of 12 kinds of medicine was tested for rifampicin (RFP), isoniazid (INH), streptomycin (SM), ethambutol (EMB), amikacin (AMK), prothioisoniazine (PTO), moxifloxacin (MOX), kanamycin (KAM), capreomycin (CPM), p-aminosalicylic acid (PAS), levofloxacin (LVFX), clarithromycin (CLA) with proportion method, and the result of drug resistance were analyzed by statistics.
Results A total of 1 259 patients infected with Mycobacterium tuberculosis, the proportion of drug resistance was 28.3% of initial treatment patients and 44.7% of retreatment patients, with statistical significance ( P<0.01). Among 268 patients infected with nontuberculous mycobacteria, the proportion of drug resistance was 97.5% of initial treatment patients and 92.5% of retreatment patients, with no statistical significance ( P=0.06) . The highest rate of drug resistance in TB patients of initial treatment and retreatment was MR-TB(12.4%, 19.5%); except for PR-TB patients of retreatment with no statistical significance, the proportion of drug resistance for MR-TB, MDR-TB and XDR-TB showed significant difference. SM, INH, RFP, EMB and CLA were the five highest drugs with drug resistance in the initial-treated patients with Mycobacterium tuberculosis, while these in the re-treated patients were INH, SM, RFP, EMB and LVFX in turn (INH, SM and RFP had the same drug resistance rate). And the six highest drugs with drug resistance rate in the initial-treated patients with nontuberculous mycobacteria infection were SM, PAS, EMB, CPM, RFP, INH (RFP had the same drug resistance rate as INH), and these in the patients with re-treatment were INH, PAS, SM, RFP, EMB.
Conclusion The drug resistance of tuberculosis and nontuberculous mycobacteria in Zhuhai was severe, and the standardized use of first-line anti-TB drugs needs to be improved. Based on drug sensitivity results, doctors need to carry out individualized therapy, improve patient compliance with medication, which would effectively reduce drug resistance.
摘要： 目的 分析珠海市结核和非结核分枝杆菌耐药情况, 为结核病防控提供依据。 方法 分析 2014 年 1 月— 2018 年 6 月珠海市慢性病防治中心培养阳性的结核和非结核分枝杆菌菌株, 菌种鉴定后采用比例法对利福平 (RFP)、异烟 肼 (INH)、链 霉 素 (SM)、乙 胺丁 醇 (EMB)、阿 米卡 星 (AMK) , 丙 硫异烟 胺 (PTO)、莫 西沙 星 (MOX)、卡 那霉素 (KAM)、卷曲霉素 (CPM)、对氨基水杨酸 (PAS)、左氧氟沙星 (LVFX)、克拉霉素 (CLA) 等 12 种药物进行耐药性检测, 并 对耐药结果进行统计分析。 结果 结核分枝杆菌感染患者 1 259 例, 初治和复治患者耐药率分别为 28.3% 和 44.7%, 差 异有统计学意义 ( P<0.01)。非结核分枝杆菌感染患者 268 例, 初治和复治患者耐药率分别为 97.5% 和 92.5%, 差异无统 计学意义 ( P=0.06)。结核分枝杆菌初复治患者中耐药率最高均为 MR-TB(12.4%, 19.5%), 初复治患者除 PR-TB 差异无 统计学意义外, MR-TB、MDR-TB 以及 XDR-TB 的耐药率差异皆有统计学意义。结核分枝杆菌初治患者耐药率最高的 五位分别为 SM、INH、RFP、EMB、CLA, 复治患者中耐药率最高的 5 种药物依次为 INH、SM、RFP、EMB、LVFX (INH、SM、RFP 三者耐药率相同) 。非结核分枝杆菌感染初治患者耐药率最高的 6 种药物依次为 SM、PAS、EMB、CPM、RFP、INH (RFP 与 INH 耐药率相同) , 复治患者耐药率最高的药物依次为：INH、PAS、SM、RFP、EMB。 结论 珠海地区结核和非结 核复治患者的耐药形势严峻, 需要加强抗结核一线药物的规范使用, 依据药敏结果进行个体化治疗, 提高患者的服药 依从性, 有效降低耐药率。