关键词: 结核,肺, 抗药性, 喹诺酮类, 危险因素, 横断面研究

Abstract:

Objective To analyze the resistance to fluoroquinolones and the influencing factors in patients with drug-resistant pulmonary tuberculosis. Methods Retrospective analysis was conducted on 988 drug-resistant tuberculosis patients diagnosed and hospitalized in Beijing Chest Hospital, Capital Medical University from January 2015 to December 2020. All the subjects were positive in sputum mycobacterium culture and the strains were identified as Mycobacterium tuberculosis. All the patients were tested for drug sensitivity, and resistant to one or more of the following drugs: isoniazid, rifampicin, rifapentine, rifabutin, ethambutol, clofazimine, amikacin, prothiazide, clarithromycin, kanamycin, capreomycin, and streptomycin, etc. Proportional drug sensitivity test was used to detect the resistance of ofloxacin, levofloxacin, and moxifloxacin, etc. The drug resistance of subjects with different characteristics to fluoroquinolones was analyzed, and the influencing factors of fluoroquinolones resistance in patients with drug-resistant pulmonary tuberculosis were analyzed by multivariate logistic regression model. Results Among the 988 subjects, 431 were resistant to fluoroquinolones, and the resistance rate was 43.62%. Of the patients with fluoroquinolones resistant, 0.93% (4/431) were aged <18 years, 17.86% (77/431) were newly treated patients, and 14.62% (63/431) lived in Beijing, all the proportions were significantly higher than those of the patients sensitive to fluoroquinolones (3.05% (17/557), 36.98% (206/557) and 31.42% (175/557), respectively; χ ² were 6.154, 43.453 and 37.508, respectively, all P<0.05); the patients with rifampicin resistance accounted for 94.66% (408/431), significantly higher than that in the patients sensitive to fluoroquinolones (84.38%, 470/557; χ ²=25.968, P<0.01); 3.81% (15/431) had a history of fluoroquinolones, and there was no significant difference compared to those who were sensitive to fluoroquinolones (2.98%, 15/557; χ ²=0.465, P=0.495). Multivariate logistic regression analysis showed that rifampicin resistance (OR(95%CI)=2.704 (1.585-4.615)) and history of fluoroquinolones (OR(95%CI)=2.661 (1.210-5.854)) were the risk factors of fluoroquinolones resistance in patients with drug-resistant pulmonary tuberculosis; while initial treatment (OR (95%CI)=0.402 (0.283-0.571)) and living in Beijing (OR (95%CI)=0.411 (0.289-0.585)) were the protective factors. Conclusion Drug-resistant pulmonary tuberculosis patients had a higher rate of resistance to fluoroquinolone drugs. The risk of fluoroquinolone drug resistance increased in patients with retreatment, rifampicin resistance, fluoroquinolone history, and non-Beijing residents.

Key words: Tuberculosis,pulmonary, Drug resistance, Quinolones, Risk factors, Cross-sectional studies