Analysis of drug resistance situation of Mycobacterium tuberculosis strains from 231 spinal tuberculosis patients

doi:10.19982/j.issn.1000-6621.20220178

Abstract

Abstract:

Objective: To analyze the drug resistance characteristics of 231 patients with spinal tuberculosis and to provide reference for clinicians to develop proper treatment regimens for spinal tuberculosis patients. Methods: The Mycobacterium tuberculosis strains and clinical data were collected from 231 culture-positive spinal tuberculosis patients, who were hospitalized in Beijing Chest Hospital from January 2016 to December 2021. Drug susceptibility test was performed for the following 16 drugs using ENCODE microplate methods: streptomycin (Sm), isoniazid (INH), rifampicin (RFP), ethambutol (EMB), rifapentine (Rft), levofloxacin (Lfx), amikacin (Am), capreomycin (Cm), prothionamide (Pto), isoniazid aminosalicylate (Pa), moxifloxacin (Mfx), p-aminosalicylic acid (PAS), clarithromycin (Clr), rifabutin (Rfb), kanamycin (Km) and clofazimine (Cfz). Results: The total drug resistance rate of those spinal tuberculosis patients to at least one of the 16 drugs was 34.63% (80/231), of which the drug resistance rate was significantly higher in previously treated patients (75.44%, 43/57) than in new patients (21.26%, 37/174), and the difference was statistically significant (χ²=55.660, P<0.001). The drug resistance rates of spinal tuberculosis patients to the 16 drugs from high to low were: Sm (24.68%, 57/231)>INH (22.51%, 52/231)>Rft (19.05%, 44/231)>RFP (18.18%, 42/231)>Pa (15.58%, 36/231)>Rfb (13.85%, 32/231)>Lfx (7.79%, 18/231)>PAS (7.36%, 17/231)>Cm (5.63%, 13/231)>Km (4.76%, 11/231)=Cfz (4.76%, 11/231)>Pto (4.33%, 10/231)=Clr (4.33%, 10/231)>EMB (3.90%, 9/231)>Am (3.46%, 8/231)>Mfx (2.60%, 6/231). The poly-drug resistance rate of spinal tuberculosis patients was 11.69% (27/231), of which the poly-drug resistance rate was significantly higher in previously treated patients (19.30%, 11/57) than in new patients (9.20%, 16/174),and the difference was statistically significant (χ²=4.246, P=0.039); The multidrug-resistance rate was 15.58% (36/231), of which the multidrug-resistance rate was significantly higher in previously treated patients (52.63%, 30/57) than in new patients (3.45%, 6/174),and the difference was statistically significant (χ²=46.980, P<0.001). Conclusion: There was serious epidemic of drug resistance in spinal tuberculosis patients. Effective treatment regimens should be developed according to the results of drug susceptibility tests.

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

CLC Number:

R529.2

Wang Chaohong, Sun Qing, Liao Xinlei, Yan Jun, Wang Chenqian, Jiang Guanglu, Wang Fen, Xue Yi, Huang Hairong, Wang Guirong. Analysis of drug resistance situation of Mycobacterium tuberculosis strains from 231 spinal tuberculosis patients[J]. Chinese Journal of Antituberculosis, 2022, 44(9): 940-946. doi: 10.19982/j.issn.1000-6621.20220178

Figures/Tables 4

References 27

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特征	初治患者 (174例)	复治患者 (57例)	合计 (231例)
性别
男性	101(58.05)	28(49.12)	129(55.84)
女性	73(41.95)	29(50.88)	102(44.16)
年龄组(岁)
0~10	1(0.57)	0(0.00)	1(0.43)
11~20	10(5.75)	6(10.53)	16(6.93)
21~30	51(29.31)	13(22.81)	64(27.71)
31~40	18(10.34)	6(10.53)	24(10.39)
41~50	23(13.22)	14(24.56)	37(16.02)
51~60	32(18.39)	12(21.05)	44(19.05)
61~70	31(17.82)	2(3.51)	33(14.29)
71~80	5(2.87)	3(5.26)	8(3.46)
>80	3(1.72)	1(1.75)	4(1.73)
职业
农民	77(44.25)	21(36.84)	98(42.42)
工人	8(4.60)	2(3.51)	10(4.33)
退(离)休人员	25(14.37)	8(14.04)	33(14.29)
无业人员	17(9.77)	8(14.04)	25(10.82)
学生	6(3.45)	6(10.53)	12(5.19)
职员	22(12.64)	8(14.04)	30(12.99)
其他^a	19(10.92)	4(7.02)	23(9.96)
患病部位
颈椎	8(4.60)	0(0.00)	8(3.46)
胸椎	60(34.48)	14(24.56)	74(32.03)
腰椎	71(40.80)	35(61.40)	106(45.89)
颈椎+胸椎	5(2.87)	0(0.00)	5(2.16)
胸椎+腰椎	29(16.67)	7(12.28)	36(15.58)
颈椎+胸椎+腰椎	1(0.57)	1(1.75)	2(0.87)
基础疾病
营养不良	95(54.60)	33(57.89)	128(55.41)
高血压	20(11.49)	8(14.04)	28(12.12)
糖尿病	16(9.20)	7(12.28)	23(9.96)
免疫性疾病	3(1.72)	3(5.26)	6(2.60)

耐药类型	合计(231例)	初治患者(174例)	复治患者(57例)	χ²值	P值
任一耐药	80(34.63)	37(21.26)	43(75.44)	55.660	<0.001
Sm	57(24.68)	24(13.79)	33(57.89)	44.930	<0.001
INH	52(22.51)	13(7.47)	39(68.42)	91.440	<0.001
RFP	42(18.18)	10(5.75)	32(56.14)	73.290	<0.001
EMB	9(3.90)	0(0.00)	9(15.79)	28.590	<0.001
Rft	44(19.05)	11(6.32)	33(57.89)	74.060	<0.001
Lfx	18(7.79)	5(2.87)	13(22.81)	23.740	<0.001
Am	8(3.46)	3(1.72)	5(8.77)	4.450	0.035
Cm	13(5.63)	7(4.02)	6(10.53)	2.300	0.129
Pto	10(4.33)	4(2.30)	6(10.53)	5.170	0.023
Pa	36(15.58)	8(4.60)	28(49.12)	64.701	<0.001
Mfx	6(2.60)	1(0.57)	5(8.77)	8.393	0.004
PAS	17(7.36)	9(5.17)	8(14.04)	3.732	0.053
Clr	10(4.33)	5(2.87)	5(8.77)	2.232	0.127
Rfb	32(13.85)	6(3.45)	26(45.61)	63.967	<0.001
Km	11(4.76)	4(2.30)	7(12.28)	7.360	0.007
Cfz	11(4.76)	4(2.30)	7(12.28)	7.360	0.007

耐药类型	合计(231例)		初治患者(174例)		复治患者(57例)		P值^a
INH+Pa	3(1.30)		2(1.15)		1(1.75)		0.574
Sm+INH	2(0.87)		1(0.57)		1(1.75)		0.433
Sm+PAS	1(0.43)		1(0.57)		0(0.00)		1.000
Cm+Clr	1(0.43)		1(0.57)		0(0.00)		1.000
RFP+Rft	1(0.43)		1(0.57)		0(0.00)		1.000
PAS+Clr	1(0.43)		1(0.57)		0(0.00)		1.000
INH+PAS	1(0.43)		1(0.57)		0(0.00)		1.000
INH+Pa+Cfz	2(0.87)		1(0.57)		1(1.75)		0.433
Lfx+Cm+Mfx	1(0.43)		1(0.57)		0(0.00)		1.000
INH+Cm+Pa	1(0.43)		0(0.00)		1(1.75)		0.247
耐药类型		合计(231例)		初治患者(174例)		复治患者(57例)	P值^a
Sm+INH+Rft		1(0.43)		0(0.00)		1(1.75)	0.247
RFP+Rft+Rfb		1(0.43)		1(0.57)		0(0.00)	1.000
Sm+RFP+Rft+Rfb		2(0.87)		1(0.57)		1(1.75)	0.433
INH+Rft+Cm+Pto+Rfb		1(0.43)		1(0.57)		0(0.00)	1.000
Sm+Cm+PAS+Clr+Cfz		1(0.43)		1(0.57)		0(0.00)	1.000
Sm+INH+Rft+PAS+Clr		1(0.43)		1(0.57)		0(0.00)	1.000
INH+Cm+Pa+PAS+Clr+Km		1(0.43)		0(0.00)		1(1.75)	0.247
Sm+RFP+Rft+PAS+Rfb+Cfz		1(0.43)		1(0.57)		0(0.00)	1.000
INH+Cm+Pa+Clr+Rfb+Km		1(0.43)		0(0.00)		1(1.75)	0.247
Sm+INH+Am+Pa+PAS+Km		2(0.87)		0(0.00)		2(3.51)	0.06
Sm+RFP+EMB+Rft+Lfx+Pa+Mfx+Rfb		1(0.43)		0(0.00)		1(1.75)	0.247
合计		27(11.69)		16(9.20)		11(19.30)	0.039

耐多药类型	合计(231例)	初治患者(174例)	复治患者(57例)	P值^a
INH+RFP+Rft	1(0.43)	0(0.00)	1(1.75)	0.247
INH+RFP+Rft+Rfb	1(0.43)	0(0.00)	1(1.75)	0.247
INH+RFP+Sm+Rft+Rfb	3(1.30)	1(0.57)	2(3.51)	0.151
INH+RFP+Rft+Pa+Rfb	1(0.43)	0(0.00)	1(1.75)	0.247
INH+RFP+Sm+Rft+Pa	2(0.87)	0(0.00)	2(3.51)	0.060
INH+RFP+Sm+Rft+Pto	1(0.43)	0(0.00)	1(1.75)	0.247
INH+RFP+Rft+Pa+PAS+Rfb	1(0.43)	0(0.00)	1(1.75)	0.247
INH+RFP+Sm+Rft+Pa+Rfb	2(0.87)	0(0.00)	2(3.51)	0.060
INH+RFP+Sm+EMB+Rft+Rfb	1(0.43)	0(0.00)	1(1.75)	0.247
INH+RFP+Sm+Rft+Lfx+Rfb	2(0.87)	0(0.00)	2(3.51)	0.060
INH+RFP+Sm+Rft+Lfx+Pto	1(0.43)	0(0.00)	1(1.75)	0.247
INH+RFP+Sm+Rft+Am+Rfb+Km	1(0.43)	0(0.00)	1(1.75)	0.247
INH+RFP+Sm+Rft+Lfx+Pa+Km	1(0.43)	1(0.57)	0(0.00)	1.000
INH+RFP+Sm+Rft+Lfx+Pa+Rfb	4(1.73)	0(0.00)	4(7.02)	0.003
INH+RFP+Sm+Rft+Pa+Rfb+Cfz	1(0.43)	0(0.00)	1(1.75)	0.247
INH+RFP+Sm+EMB+Rft+Pa+Rfb	2(0.87)	0(0.00)	2(3.51)	0.060
INH+RFP+Sm+Rft+Pa+PAS+Rfb+Cfz	1(0.43)	0(0.00)	1(1.75)	0.247
INH+RFP+Sm+Rft+Am+Cm+Pa+Km	1(0.43)	1(0.57)	0(0.00)	1.000
INH+RFP+Sm+EMB+Rft+Lfx+Pa+Rfb	1(0.43)	0(0.00)	1(1.75)	0.247
INH+RFP+Sm+EMB+Rft+Lfx+Pa+Mfx	1(0.43)	0(0.00)	1(1.75)	0.247
INH+RFP+Sm+Rft+Lfx+Pto+Pa+Rfb	1(0.43)	0(0.00)	1(1.75)	0.247
INH+RFP+Sm+Rft+Lfx+Pa+PAS+Rfb	1(0.43)	1(0.57)	0(0.00)	1.000
INH+RFP+Sm+Lfx+Am+Cm+Pto+Pa+PAS+Km	1(0.43)	1(0.57)	0(0.00)	1.000
INH+RFP+Sm+Rft+Lfx+Am+Cm+Pto+Pa+PAS+Km	1(0.43)	1(0.57)	0(0.00)	1.000
INH+RFP+Sm+EMB+Rft+Cm+Pto+Pa+Mfx+PAS+Clr+Rfb+Cfz	1(0.43)	0(0.00)	1(1.75)	0.247
INH+RFP+Sm+EMB+Rft+Lfx+Am+Cm+Pto+Pa+Mfx+PAS+Clr+Km+Cfz	2(0.87)	0(0.00)	2(3.51)	0.060
合计	36(15.58)	6(3.45)	30(52.63)	<0.001