摘要
目的分析四川大学华西医院近年来结核分枝杆菌复合群(Mycobacterium tuberculosis complex,MTBC)耐药情况和变化趋势,为综合医院的结核病耐药监测和防治策略提供参考。方法收集四川大学华西医院2019年1月—2022年12月MTBC临床分离株中进行了药物敏感性(药敏)试验的菌株。收集这些菌株对利福平、异烟肼、乙胺丁醇、链霉素、利福布汀、阿米卡星、卡那霉素、氧氟沙星、左氧氟沙星、莫西沙星、对氨基水杨酸、乙硫异烟胺及卷曲霉素13种抗结核药物的药敏信息进行回顾分析。结果共纳入502株MTBC菌株,其中366株来源于初治患者,136株来源于复治患者。纳入的MTBC菌株对一线抗结核药物耐药率从高到低依次为异烟肼28.69%、乙胺丁醇19.72%、利福平14.94%;二线药物中,对氧氟沙星、左氧氟沙星和莫西沙星的耐药率依次为13.55%、12.15%和11.95%,对阿米卡星、卡那霉素、对氨基水杨酸和乙硫异烟胺的耐药率均<10%,对链霉素、卷曲霉素和利福布汀的耐药率依次为17.53%、13.55%和12.15%。复治患者对除卷曲霉素以外的其余12种抗结核药物的耐药率均高于初治患者,且差异有统计学意义(P<0.05)。单耐药、多耐药、耐多药及准广泛耐药菌株分离率分别为9.36%、7.37%、7.17%和7.77%,4种耐药表型的菌株分离率4年间均呈总体下降趋势,变化趋势有统计学意义(P<0.05)。复治患者耐多药和准广泛耐药菌株分离率均高于初治患者,差异有统计学意义(P<0.001)。结论四川大学华西医院作为综合性结核定点医院2019年—2022年结核耐药情况仍较为严峻,应进一步加强结核病的防治和耐药监测。
Objective To analyze the drug resistance of Mycobacterium tuberculosis complex(MTBC)in West China Hospital of Sichuan University in recent years to provide reference for drug resistance monitoring and prevention strategies of tuberculosis in general hospitals.Methods The clinical strains of MTBC that performed drug susceptibility tests in West China Hospital of Sichuan University between January 2019 and December 2022 were collected.The drug susceptibility information of 13 anti-tuberculosis drugs,namely rifampicin,isoniazid,ethambutol,streptomycin,rifabutin,amikacin,kanamycin,ofloxacin,levofloxacin,moxifloxacin,para-aminosalicylic acid,ethionamide,and capreomycin,was collected and retrospectively analyzed.Results A total of 502 clinical strains of MTBC were included,and 366 of them were isolated from newly-treated patients while 136 form re-treated patients.The resistance rates of MTBC strains to the first-line anti-tuberculosis drugs in descending order were 28.69%(isoniazid),19.72%(ethambutol),and 14.94%(rifampicin).Among the second-line drugs,the resistance rates to ofloxacin,levofloxacin,and moxifloxacin were 13.55%,12.15%,and 11.95%,respectively.The resistance rates to amikacin,kanamycin,para-aminosalicylic acid,and ethionamide were all less than 10%.The resistance rates to streptomycin,capreomycin,and rifabutin were 17.53%,13.55%,and 12.15%,respectively.The resistance rates to the remaining 12 anti-tuberculosis drugs except capreomycin of MTBC strains isolated from re-treated patients were higher than those of MTBC strains isolated from newly-treated patients,and the differences were statistically significant(P<0.05).The isolation rates of monodrug-resistant,polydrug-resistant,multidrug-resistant(MDR)and pre-extensively drug-resistant(pre-XDR)strains were 9.36%,7.37%,7.17%,and 7.77%,respectively.The isolation rates of strains with the four drug-resistant phenotypes generally showed a downward trend during the four years,and the changing trends were statistically significant(P<0.05).The isolation rates of MDR and pre-XDR strains from re-treated patients were higher than those from newly-treated patients,and the differences were statistically significant(P<0.001).Conclusion Tuberculosis drug resistance in West China Hospital of Sichuan University,which is a comprehensive tuberculosis-designated hospital,remained severe during the four years from 2019 to 2022,and the prevention of tuberculosis and the monitoring of drug resistance should be further strengthened.
作者
熊丽
周丹
李梦娇
舒玲
吴重阳
李冬冬
谢轶
XIONG Li;ZHOU Dan;LI Mengjiao;SHU Ling;WU Chongyang;LI Dongdong;XIE Yi(Department of Laboratory Medicine,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,P.R.China)
出处
《华西医学》
CAS
2024年第8期1179-1183,共5页
West China Medical Journal
基金
四川省自然科学基金(2024NSFSC1539)。
关键词
结核分枝杆菌复合群
综合医院
耐药性
Mycobacterium tuberculosis complex
comprehensive hospital
drug resistance
