Analysis of drug susceptibility of 680 patients with multidrug-resistant tuberculosis in Xi’an City from 2015 to 2019

doi:10.3969/j.issn.1000-6621.2020.06.013

Abstract

Abstract:

Objective A retrospective analysis of drug susceptibility test (DST) results of multidrug-resistant tuberculosis(MDR-TB) patients was carried out to provide evidence for guiding clinical drug administration for MDR-TB patients. Methods All of 680 MDR-TB patients in Xi’an City from 2015 to 2019 were selected as study subjects. The DST results of ethambutol (EMB), streptomycin (Sm), protionamide (Pto), amikacin (Am), capreomycin (Cm), P-aminosalicylic acid (PAS), levofloxacin (Lfx) and moxifloxacin (Mfx) were collected and analyzed. Results (1)The rates of resistance to different drugs could be listed from high to low as: Sm (85.7% (583/680)), Lfx (40.1% (273/680)), EMB (37.5% (255/680)), Mfx (31.3% (213/680)), PAS (14.4% (98/680)), Pto (4.6% (31/680)), Am (4.4% (30/680)), and Cm (4.3% (29/680));(2)The rates of resistance to several second-line anti-tuberculosis drugs decreased from 2015 to 2019:Am (from 6.9% decreased to 3.0%,$\chi^{2}_{trends}$=2.78,P=0.096), Cm (10.3%/3.0%,$\chi^{2}_{trends}$=6.96,P=0.008), Lfx (55.2%/28.4%,$\chi^{2}_{trends}$=24.97,P=0.000), Mfx (43.1%/22.9%,$\chi^{2}_{trends}$=16.45,P=0.000), Pto (6.9%/6.0%,$\chi^{2}_{trends}$=0.44,P=0.506), Pas (20.7%/8.0%,$\chi^{2}_{trends}$=7.79,P=0.005).(3)Cross resistance of second-line anti-tuberculosis drugs: among 30 cases resistant to Am, 21 (70.0%) cases were resistant to Cm; in 29 cases resistant to Cm, 21 (72.4%) cases were resistant to Am; 205 (75.1%) cases were resistant to Mfx in 273 Lfx-resistant cases, 205 (96.2%) cases were resistant to Lfx in 213 Mfx-resistant cases. Conclusion In these 5 years, MDR-TB patients in Xi’an City kept a high resistance rate to EMB and Sm. The drug resistance rates of second-line anti-tuberculosis drugs decreased, but we still need to pay attention to the high resistance rate of quinolone. Those resistance rates to different drug and high cross-resistance rate among second-line anti-tuberculosis drugs should be considered when selecting drugs.

Key words: Drug resistance, multiple, Microbial sensitivity tests, Data interpretation, statistical, Xi’an

MA Jin-bao, REN Fei, ZENG Ling-cheng, CHEN Ming-wei. Analysis of drug susceptibility of 680 patients with multidrug-resistant tuberculosis in Xi’an City from 2015 to 2019[J]. Chinese Journal of Antituberculosis, 2020, 42(6): 609-613. doi: 10.3969/j.issn.1000-6621.2020.06.013

Figures/Tables 4

药品名称	2015年 (58例^a)	2016年 (135例^a)	2017年 (147例^a)	2018年 (139例^a)	2019年 (201例^a)	$χ 趋势 2$ 值	P值
Sm	45(77.6)	113(83.7)	136(92.5)	123(88.5)	166(82.6)	0.08	0.780
EMB	22(37.9)	51(37.8)	70(47.6)	48(34.5)	64(31.8)	2.77	0.096
Am	4(6.9)	6(4.4)	11(7.5)	3(2.2)	6(3.0)	2.78	0.096
Cm	6(10.3)	7(5.2)	9(6.1)	1(0.7)	6(3.0)	7.00	0.008
Lfx	32(55.2)	67(49.6)	68(46.3)	49(35.3)	57(28.4)	24.97	0.000
Mfx	25(43.1)	51(37.8)	56(38.1)	35(25.2)	46(22.9)	16.45	0.000
Pto	4(6.9)	3(2.2)	7(4.8)	5(3.6)	12(6.0)	0.44	0.506
PAS	12(20.7)	19(14.1)	32(21.8)	19(13.7)	16(8.0)	7.79	0.005

References 22

[1]	World Health Organization. The end TB strategy. Geneva:World Health Organization, 2015.
[2]	吕德良, 谭卫国, 张乐平 , 等. 深圳市耐多药结核病治疗效果及影响因素分析. 中国防痨杂志, 2017,39(2):184-190.
[3]	李玲, 姚嵩, 邹铮 , 等. 全球基金结核病项目安徽省试点耐多药结核病综合防治效果分析. 中国防痨杂志, 2017,39(7):728-731.
[4]	李凤丽, 阚晓红, 李琦 , 等. MDR-TB患者采用不同化疗方案所致药物不良反应及治疗转归研究. 中国防痨杂志, 2018,40(8):805-809.
[5]	中国防痨协会. 耐药结核病化学治疗指南(2019年简版). 中国防痨杂志, 2019,41(10):1025-1073.
[6]	赵雁林, 王黎霞, 成诗明 , 等. 结核分枝杆菌药物敏感性试验标准化操作程序及质量保证手册. 北京: 人民卫生出版社, 2013.
[7]	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.
[8]	邓亚丽, 张宏伟, 张天华 , 等. 陕西省新型结核病防治管理模式实施前后能力建设与诊治效果分析. 中国防痨杂志, 2018,40(12):1341-1345.
[9]	赵冰, 宋媛媛, 逄宇 , 等. 中国耐多药结核分枝杆菌二线抗结核药物敏感性分析. 中国防痨杂志, 2013,35(10):831-834.
[10]	中国防痨协会. 耐药结核病化学治疗指南(2019年).北京: 人民卫生出版社, 2019.
[11]	World Health Organization. WHO consolidated guidelines on drug-resistant tuberculosis treatment. Geneva: World Health Organization, 2019.
[12]	杨华, 胡忠义, 沙巍 , 等. 结核分枝杆菌对氧氟沙星耐药的体外诱导及稳定性研究. 中华预防医学杂志, 2014,48(4):318-323.
[13]	马进宝, 杨翰, 任斐 , 等. 三种分子生物学方法检测结核分枝杆菌耐药性的效能分析. 中国防痨杂志, 2019,41(4):440-446.
[14]	中国防痨协会. 耐药结核病化学治疗指南(2015). 中国防痨杂志, 2015,37(5):421-469.
[15]	曹广云, 肖和平, 闫丽萍 , 等. 三种注射用抗结核药物对结核分枝杆菌的耐药情况分析. 中国防痨杂志, 2010,32(4):227-230.
[16]	Du Q, Dai G, Long Q , et al. Mycobacterium tuberculosis rrs A1401G mutation correlates with high-level resistance to kanamycin, amikacin, and capreomycin in clinical isolates from mainland China. Diagn Microbiol Infect Dis, 2013,77(2):138-142.
[17]	车洋, 杨天池, 于梅 , 等. 116例耐多药结核分枝杆菌临床分离株对4种注射用抗结核药物耐药及交叉耐药分析. 中国卫生检验杂志, 2016,26(12):1802-1804.
[18]	何贵清, 施伎蝉, 吴联朋 , 等. 耐多药肺结核患者基线菌株二线抗结核药物耐药情况分析. 中国现代医生, 2018,56(15):84-87.
[19]	刘银萍, 王杰, 张俊仙 , 等. 对异烟肼与丙硫异烟胺耐药的结核分枝杆菌临床分离株检测及相关基因突变的研究. 中国防痨杂志, 2016,38(9):718-721.
[20]	Huo F, Lu J, Zong Z , et al. Change in prevalence and molecular characteristics of isoniazid-resistant tuberculosis over a 10-year period in China. BMC Infect Dis, 2019,19(1):689.
[21]	党丽云, 魏香兰, 方如塘 , 等. 4721例住院肺结核患者耐药状况及危险因素分析. 中国防痨杂志, 2014,36(1):49-54.
[22]	Lu Z, Jiang W, Zhang J , et al. Drug resistance and epidemiology characteristics of multidrug-resistant tuberculosis patients in 17 provinces of China. PLoS One, 2019,14(11):e0225361.

患者类别	例数	耐Sm		耐EMB		耐Am		耐Cm		耐Lfx		耐Mfx		耐Pto		耐PAS
患者类别	例数	例数	率(%)	例数	率(%)	例数	率(%)	例数	率(%)	例数	率(%)	例数	率(%)	例数	率(%)	例数	率(%)
初治	346	308	89.0	112	32.4	10	2.9	10	2.9	123	35.5	98	28.3	12	3.5	53	15.3
复治	334	275	82.3	143	42.8	20	6.0	19	5.7	150	44.9	115	34.4	19	5.7	45	13.5
χ²值		6.20		7.91		3.86		3.26		6.19		2.94		1.92		0.46
P值		0.013		0.005		0.049		0.071		0.013		0.086		0.165		0.493