Analysis of drug resistance of clinical isolates of smear positive pulmonary tuberculosis patients in Shaanxi Province from 2017 to 2018

doi:10.3969/j.issn.1000-6621.2019.06.006

Abstract

Abstract:

Objective To explore the drug resistance of Mycobacterium tuberculosis(MTB) isolated from smear-positive pulmonary tuberculosis (TB) patients in Shaanxi Province.Methods Twenty-six survey points in Shaanxi Province were extracted with stratified cluster random sampling. All the culture positive isolated strains from new smear positive pulmonary TB patients registered from January 2017 to December 2018 were collected. Twenty-two strains were identified as non-tuberculosis mycobacteria (NTM) which accounted for 2.23% (22/987), and 965 strains were identified as MTB which accounted for 97.77% (965/987). Drug susceptibility test of 6 anti-TB drugs (including isoniazid (INH), rifampicin (RFP), ethambutol (EMB), streptomycin (Sm), ofloxacin (Ofx), kanamycin (Km)) with proportional method were performed on 965 strains of MTB. SPSS 18.0 was used for statistical analysis, and the counting data were analyzed by Chi-square test or Fisher exact test. P<0.05 was considered statistically significant.Results The drug resistance rate of 965 MTB strains was 28.50% (275/965), 26.07% (219/840) for initially-treated patients and 44.80% (56/125) for re-treated patients. The mono-resistance rate was 14.30% (138/965), 14.76% (124/840) for initially-treated patients and 11.20% (14/125) for re-treated patients. The poly-drug resistance rate was 4.56% (44/965), 4.40% (37/840) for initially-treated patients and 5.60% (7/125) for re-treated patients. The multi-drug resistance rate was 6.53% (63/965), 4.40% (37/840) for initial patients and 20.80% (26/125) for re-treated patients. The extensive drug resistance rate was 0.62% (6/965), 0.24% (2/840) for initially-treated patients and 3.20% (4/125) for re-treated patients. The rifampicin resistance rate was 9.84% (95/965), 7.14% (60/840) for initially-treated patients and 28.00% (35/125) for re-treated patients. The drug resistance rate, multi-drug resistance rate and rifampicin resistance rate of re-treated patients were significantly higher than those of initially-treated patients (χ²=18.730, 47.930 and 53.331 respectively, all P=0.000). The drug resistance rate to 4 first-line and 2 second-line anti-TB drugs were 26.01% (251/965) and 8.50% (82/965), respectively. It showed the highest resistance to Sm (17.62%, 170/965), followed by INH (15.03%, 145/965), RFP (9.84%, 95/965), Ofx (6.84%, 66/965), EMB (5.08%, 49/965) and Km (2.59%, 25/965).There were 39 types of drug resistance spectrum, which included 6 mono-resistance, 5 poly-drug resistance, 13 multi-drug resistance and 15 kinds of poly-drug resistance of second-line drugs.Conclusion In recent years, some achievements have been made in the prevention and control of drug-resistant TB in Shaanxi Province, but the drug resistance spectrum presents polymorphism and complexity, and the epidemic of multi-drug resistance and rifampicin resistance is still severe.

Key words: Tuberculosis, pulmonary, Microbial sensitivity tests, Tuberculosis, multi-drug resistant, Data interpretation, statistical, Shaanxi Province

Jian YANG,Tian-hua ZHANG,Xiao-ping XIAN,Yan LI,Rui WANG. Analysis of drug resistance of clinical isolates of smear positive pulmonary tuberculosis patients in Shaanxi Province from 2017 to 2018[J]. Chinese Journal of Antituberculosis, 2019, 41(6): 616-623. doi: 10.3969/j.issn.1000-6621.2019.06.006

Figures/Tables 5

References 26

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耐药类型	初治(840株)			复治(125株)			合计(965株)			χ²值	P值^a
耐药类型	耐药株数	耐药率 (%)	95%CI(%)	耐药株数	耐药率 (%)	95%CI(%)	耐药株数	耐药率 (%)	95%CI(%)	χ²值	P值^a
耐药	219	26.07	23.11~29.03	56	44.80	36.08~53.52	275	28.50	25.66~31.34	18.730	0.000
单耐药	124	14.76	12.36~17.16	14	11.20	5.67~16.73	138	14.30	12.09~16.51	1.126	0.289
多耐药	37	4.40	3.01~5.79	7	5.60	1.56~9.64	44	4.56	3.25~5.87	0.357	0.550
耐多药	37	4.40	3.01~5.79	26	20.80	13.69~27.91	63	6.53	4.96~8.10	47.930	0.000
广泛耐药	2	0.24	0.03~0.86	4	3.20	0.89~7.81	6	0.62	0.23~1.32	-^b	0.003
RFP耐药	60	7.14	5.40~8.88	35	28.00	20.13~35.87	95	9.84	7.96~11.72	53.331	0.000

耐药情况	初治(840株)			复治(125株)			合计(965株)			χ²值	P值^a
耐药情况	耐药株数	耐药率 (%)	95%CI(%)	耐药株数	耐药率 (%)	95%CI(%)	耐药株数	耐药率 (%)	95%CI(%)	χ²值	P值^a
对一线药耐药	195	23.21	20.35~26.07	56	44.80	36.08~53.52	251	26.01	23.24~28.78	26.344	0.000
INH	107	12.74	10.49~14.99	38	30.40	22.34~38.46	145	15.03	12.78~17.28	26.583	0.000
RFP	60	7.14	5.40~8.88	35	28.00	20.13~35.87	95	9.84	7.96~11.72	53.331	0.000
EMB	33	3.93	3.26~4.60	16	12.80	6.94~18.66	49	5.08	3.69~6.47	17.769	0.000
Sm	130	15.48	13.03~17.93	40	32.00	23.82~40.18	170	17.62	16.39~18.85	20.470	0.000
对二线药耐药	56	6.67	4.98~8.36	26	20.80	13.68~27.92	82	8.50	6.74~10.26	27.953	0.000
Ofx	45	5.36	3.84~6.88	21	16.80	10.25~23.35	66	6.84	5.25~8.43	22.361	0.000
Km	15	1.79	0.89~2.69	10	8.00	3.39~12.61	25	2.59	1.59~3.59	16.651	0.000

耐药谱	初治(219株)		复治(56株)		合计(275株)
耐药谱	耐药株数	构成比(%)	耐药株数	构成比(%)	耐药株数	构成比(%)
单耐药
INH	29	23.39	3	21.43	32	23.19
RFP	11	8.87	4	28.57	15	10.87
EMB	5	4.03	1	7.14	6	4.35
Sm	55	44.35	6	42.86	61	44.20
Ofx	18	14.52	0	0.00	18	13.04
Km	6	4.84	0	0.00	6	4.35
合计	124	100.00	14	100.00	138	100.00
多耐药
INH+EMB	2	5.41	1	14.29	3	6.82
INH+Sm	29	78.38	4	57.13	33	75.00
耐药谱	初治(219株)		复治(56株)		合计(275株)
耐药谱	耐药株数	构成比(%)	耐药株数	构成比(%)	耐药株数	构成比(%)
INH+EMB+Sm	2	5.41	1	14.29	3	6.82
RFP+EMB	1	2.70	0	0.00	1	2.27
RFP+Sm	3	8.10	1	14.29	4	9.09
合计	37	100.00	7	100.00	44	100.00
耐多药
INH+RPF	5	13.52	1	3.85	6	9.53
INH+RPF+EMB	4	10.81	0	0.00	4	6.35
INH+RPF+Sm	10	27.03	4	15.38	14	22.22
INH+RFP+EMB+Sm	7	18.92	4	15.38	11	17.46
INH+RFP+EMB+Km+Ofx	1	2.70	0	0.00	1	1.59
INH+RFP+Sm+Km+Ofx	1	2.70	2	7.69	3	4.76
INH+RFP+EMB+Sm+Ofx+Km	0	0.00	2	7.69	2	3.17
INH+RFP+Ofx	1	2.70	1	3.85	2	3.17
INH+RFP+EMB+Ofx	1	2.70	1	3.85	2	3.17
INH+RFP+Sm+Ofx	1	2.70	5	19.23	6	9.53
INH+RFP+Sm+Km	0	0.00	2	7.69	2	3.17
INH+RFP+EMB+Sm+Ofx	6	16.22	3	11.54	9	14.29
INH+RFP+EMB+Sm+Km	0	0.00	1	3.85	1	1.59
合计	37	100.00	26	100.00	63	100.00
含二线药多耐药
INH+Ofx	2	9.52	1	11.11	3	10.00
INH+Km	1	4.76	0	0.00	1	3.33
INH+Sm+Ofx	1	4.76	0	0.00	1	3.33
INH+Sm+Km	3	14.29	1	11.11	4	13.33
INH+EMB+Sm+Ofx	0	0.00	1	11.11	1	3.33
INH+Sm+Ofx+Km	1	4.76	0	0.00	1	3.33
RFP+Ofx	0	0.00	2	22.23	2	6.68
RFP+Km	1	4.76	0	0.00	1	3.33
RFP+EMB+Ofx	0	0.00	1	11.11	1	3.33
RFP+Sm+Ofx	3	14.29	0	0.00	3	10.00
RFP+EMB+Sm+Ofx	3	14.29	0	0.00	3	10.00
RFP+Sm+Km+Ofx	1	4.76	1	11.11	2	6.68
EMB+Ofx	1	4.76	0	0.00	1	3.33
Sm+Ofx	4	19.05	1	11.11	5	16.67
Sm+Km	0	0.00	1	11.11	1	3.33
合计	21	100.00	9	100.00	30	100.00

患者特征	分离株数	耐药				耐多药				RFP耐药
患者特征	分离株数	耐药株数	率 (%)	χ²值	P值	耐药株数	率 (%)	χ²值	P值	耐药株数	率 (%)	χ²值	P值
性别				0.596	0.440			0.194	0.659			1.382	0.240
男	681	199	29.22			46	6.75			72	10.57
女	284	76	26.76			17	5.99			23	8.10
年龄组(岁)				10.933	0.012			7.530	0.057			8.145	0.043
≤20	61	18	29.51			3	4.92			3	4.92
21~	363	105	28.93			23	6.34			36	9.92
41~	313	105	33.55			29	9.27			41	13.10
＞60	228	47	20.61			8	3.51			15	6.58

耐药类型	关中地区(356株)		陕南地区(383株)		陕北地区(226株)		χ²值^a	P值
耐药类型	耐药株数	耐药率(%)	耐药株数	耐药率(%)	耐药株数	耐药率(%)	χ²值^a	P值
耐药	114	32.02	123	32.11	38	16.81	19.770	0.000
单耐药	53	14.89	66	17.23	19	8.41	9.191	0.010
多耐药	24	6.74	14	3.66	6	2.65	6.499	0.039
耐多药	23	6.46	29	7.57	11	4.87	1.708	0.426
广泛耐药	1	0.28	5	1.31	0	0.00	-^b	0.162
RFP耐药	41	11.52	41	10.70	13	5.75	5.706	0.058