Analysis of 894 strains of Mycobacterium tuberculosis resistance to first-line anti-tuberculosis drugs

doi:10.3969/j.issn.1000-6621.2019.03.023

Abstract

Abstract:

The clinical isolates of Mycobacterium tuberculosis in sputum specimens of 894 patients with tuberculosis in 9 Cities (States) of Jilin Province from January 2016 to March 2018 were collected and analyzed. The susceptibility tests of rifampicin (RFP), isoniazid (INH), streptomycin (Sm) and ethambutol (EMB) were carried out. Among 894 strains of Mycobacterium tuberculosis, 546 (61.07%) were susceptible to first-line drugs, 348 (38.93%) were resistant to first-line drugs. The resistance rate was 36.30% (265/730) for initial treatment cases and 50.61% (83/164) for retreatment cases, and the difference was statistically significant (χ ²=11.53, P=0.001). The total multidrug-resistance rate was 10.07% (90/894). The drug resistance rate was higher in retreatment cases (20.73%, 34/164) than initial treatment cases (7.67%, 56/730), and the difference was statistically significant (χ ²=25.23,P=0.001). The drug resistance rate of all patients to first-line anti-TB drugs was Sm (25.95%, 232/894)>INH (18.57%, 166/894)>RFP (17.23%, 154/894)>EMB (9.73%, 87/894). The tuberculosis patients in Jilin Province have high resistance to first-line drugs, especially the retreatment patients. The situation of drug-resistant tuberculosis prevention and control is still serious, and the prevention and control of tuberculosis needs to be strengthened.

Key words: Mycobacterium tuberculosis, Microbial sensitivity tests, Tuberculosis, multidrug-resistant, Data interpretation, statistical

Wei ZHAO,Si-jie LIU,Ke-wei LI,Li SHEN,Xin LIU,Peng QI,Xiu-jun YANG. Analysis of 894 strains of Mycobacterium tuberculosis resistance to first-line anti-tuberculosis drugs[J]. Chinese Journal of Antituberculosis, 2019, 41(3): 364-368. doi: 10.3969/j.issn.1000-6621.2019.03.023

Figures/Tables 2

References 23

[1]	World Health Organization. Global tuberculosis report 2017. Geneva: World Health Organization, 2017.
[2]	崔哲哲, 林玫, 刘飞鹰 , 等. 结核分枝杆菌感染诊断与防治措施的研究进展. 中华医院感染学杂志, 2015,25(15):3598-3600. doi: 10.11816/cn.ni.2015-144387 URL
[3]	Dalton T, Cegielski P, Akksilp S , et al. Prevalence of and risk factors for resistance to second-line drugs in people with multidrug-resistant tuberculosis in eight countries: a prospective cohort study. Lancet, 2012,380(9851):1406-1417. doi: 10.1016/S0140-6736(12)60734-X URL pmid: 22938757
[4]	Zielonka TM . Epidemiological situation of tuberculosis in the world based on a report of the World Health Organization 2013. Przegl Epidemiol, 2015,69(4):687-691. URL pmid: 27139345
[5]	姜世闻, 胡屹, 张慧 , 等. 耐药结核病的流行简况. 中国防痨杂志, 2010,32(6):351-353.
[6]	赵雁林 , 中国防痨协会基础委员会. 结核病实验室诊断技术培训教程. 北京: 人民卫生出版社, 2014: 92-99.
[7]	白云龙, 袁燕莉, 杨修军 , 等. 吉林省结核病耐药性调查研究报告. 中国地方病防治杂志, 2014,29(6):412-414.
[8]	全国第五次结核病流行病学抽样调查技术指导组, 全国第五次结核病流行病学抽样调查办公室. 2010年全国第五次结核病流行病学抽样调查报告. 中国防痨杂志, 2012,34(8):485-508.
[9]	钟威, 杨立军, 何琳 , 等. 辽宁省肺结核患者耐药状况及相关因素分析. 中国热带医学, 2017,17(3):221-225. doi: 10.13604/j.cnki.46-1064/r.2017.03.03 URL
[10]	王海英 . 山东省耐药结核病的流行及特征. 上海: 复旦大学, 2014: 1-113.
[11]	陈松华, 吴蓓蓓, 柳正卫 , 等. 浙江省结核病耐药状况分析. 预防医学, 2016,28(8):757-761, 765.
[12]	李雨晴, 万李, 陈杏 , 等. 中国西北四省(区)结核分枝杆菌分离株一线药物耐药状况及其影响因素分析. 中国人兽共患病学报, 2017,33(5):398-402. doi: 10.3969/j.issn.1002-2694.2017.05.003 URL
[13]	陈杏, 李雨晴, 万李 , 等. 中国西南地区结核分枝杆菌临床分离菌株一线药物耐药状况调查. 中国人兽共患病学报, 2017,33(4):300-304. doi: 10.3969/j.issn.1002-2694.2017.04.002 URL
[14]	袁燕莉, 杨修军, 杨光旭 , 等. 吉林省结核病耐药监测研究. 中国卫生工程学, 2015,14(1):70-73, 75.
[15]	Liu Q, Zhu L, Shao Y , et al. Rates and risk factors for drug resistance tuberculosis in Northeastern China. BMC Public Health, 2013,13:1171. doi: 10.1186/1471-2458-13-1171 URL pmid: 3878749
[16]	刘彬彬, 胡培磊, 龚道方 , 等. 湖南省涂阳肺结核患者结核分枝杆菌耐药谱及其影响因素. 中国感染控制杂志, 2016,15(2):73-78. doi: 10.3969/j.issn.1671-9638.2016.02.001 URL
[17]	Merza MA, Farnia P, Tabarsi P , et al. Anti-tuberculosis drug resistance and associated risk factors in a tertiary level TB center in Iran: a retrospective analysis. J Infect Dev Ctries, 2011,5(7):511-519. doi: 10.3855/jidc.1259 URL pmid: 21795819
[18]	宋艺, 万李, 陈双双 , 等. 中国6个省份结核分枝杆菌耐药状况及影响因素分析. 中华流行病学杂志, 2016,37(7):945-948. doi: 10.3760/cma.j.issn.0254-6450.2016.07.008 URL
[19]	高谦, 梅建 . 传播才是造成我国结核病高耐药率的主要原因. 中国防痨杂志, 2015,37(11):1091-1096. doi: 10.3969/j.issn.1000-6621.2015.11.002 URL
[20]	邱蕾, 王剑, 杜斐斐 , 等. 96例耐药肺结核患者临床治疗结果分析. 结核病与肺部健康杂志, 2017,6(1):57-60. doi: 10.3969/j.issn.2095-3755.2017.01.014 URL
[21]	宋涛, 曾华志, 梁志强 , 等. 耐多药肺结核服药管理模式对患者服药依从性的效果研究. 结核病与肺部健康杂志, 2017,6(2):148-152. doi: 10.3969/j.issn.2095-3755.2017.02.016 URL
[22]	黄静静, 熊昌富, 王春雷 , 等. 2013—2014年海南省初复治涂阳肺结核患者耐药监测结果分析. 中国防痨杂志, 2017,39(1):95-99. doi: 10.3969/j.issn.1000-6621.2017.01.021 URL
[23]	钟球, 尹建军, 钱明 , 等. 广东省结核病耐药性基线调查研究. 中国防痨杂志, 2011,33(7):393-399.

耐药类型	初治患者(730例)		复治患者(164例)		合计(894例)
耐药类型	例数	耐药率(%)	例数	耐药率(%)	例数	耐药率(%)
任一耐药
耐INH	118	16.16	48	29.27	166	18.57
耐RFP	103	14.11	51	31.10	154	17.23
耐EMB	63	8.63	24	14.63	87	9.73
耐Sm	180	24.66	52	31.71	232	25.95
单一耐药
INH	28	3.84	8	4.88	36	4.03
RFP	24	3.29	9	5.49	33	3.69
EMB	13	1.78	0	0.00	13	1.45
Sm	81	11.10	18	10.98	99	11.07
耐多药
INH+RFP	12	1.64	8	4.88	20	2.24
INH+RFP+Sm	17	2.33	5	3.05	22	2.46
INH+RFP+EMB	5	0.68	6	3.66	11	1.23
INH+RFP+EMB+Sm	22	3.01	15	9.15	37	4.14
多耐药
INH+EMB	3	0.41	0	0.00	3	0.34
INH+Sm	25	3.42	5	3.05	30	3.36
RFP+EMB	0	0.00	0	0.00	0	0.00
RFP+Sm	15	2.05	6	3.66	21	2.35
EMB+Sm	6	0.82	0	0.00	6	0.67
INH+EMB+Sm	6	0.82	1	0.61	7	0.78
RFP+EMB+Sm	8	1.10	2	1.22	10	1.12

临床特征	菌株数	任一耐药
临床特征	菌株数	菌株数	耐药率 (%)	χ²值	P值	菌株数	耐药率 (%)	χ²值	P值
性别				0.18	0.668			1.13	0.289
男	685	264	38.54			73	10.66
女	209	84	40.19			17	8.13
年龄(岁)				0.36	0.835			0.27	0.876
≤30	123	50	40.65			11	8.94
31~	527	201	38.14			55	10.44
≥60	244	97	39.75			24	9.84
治疗史				11.53	0.001			25.23	0.001
初治	730	265	36.30			56	7.67
复治	164	83	50.61			34	20.73