关键词: 结核, 耐药监测, 经验与教训

Abstract: Objective To analyze the experiences and lessons in two rounds of drug resistance surveillance in Henan province for reference to the colleagues who are going to do DRS. Methods Collected and analyzed the materials from the summarized report and special report in two rounds DRS in He’nan province. Then analyzed the main problems and lined it in the tables for comparing and statistics. After discussing, the main participated working staffs gave the ideas and suggestions. Results (1) If the drug using history was not clearly asked, it would miss categorized the retreatment cases into the initial treatment group, then it would increased the drug resistant rate of initial treatment group falsely. So it must be done that drug using history should be rechecked by different leaders or senior doctors in TB dispensary, supervised by specialists from WHO, national and provincial lab, and emphasized to doctors working in dispensary again during training . (2) In the cold season or area, if the CPB was put in sample of sputum as antiseptic, the crystal of CPB and no growth of TB, contamination of other bacteria would be presented in it obviously. When stopped putting CPB into sample of sputum and changed the place of TB culture to county lab of TB dispensary, the problems mentioned above disappeared almost, and the social benefit would be increased. (3) To prevent from contamination, no growth, and baking of culturing strains, a series of measures must be done before the starting of first DRS at the county dispensary, as follows: checking, repairing or renewing the equipments for TB culture setting, up new mesures for continuous supplement of electricity and technical training to technician of TB dispensary on TB culture. (4) It is necessary that to strengthen the training for leaders and doctors working in county TB dispensary and add the times of supervising of higher supervisors at the beginning so that to prevent from selecting TB patients irregularly and make the sample better representative. (5) Using bright light magloscope for colony counting and two persons or more for rechecking, and using N·N-dimethylformamide as a replacement for rifampicin solvent, we corrected the higher sensitivity and lower specificity in the beginning of DRS and soon it were up to standard of WHO. Conclusion Paying great attention to the three principles recommended by the WHO/IUATLD’S DRS guideline and practicing it seriously is the basement of making DRS success in any country, province or area. Our experiences and lessons on previous DRS presented above were also focused on it. Do remember and practice the three principles: sample must be representative, history of anti-TB drug used should be corrected, and lab technique should be qualified and up to standard of WHO/IUATLD.

Key words: Tuberculosis, Drug resistance surveillance (DRS), Experience and lesson