摘要
目的 分析南京地区近5年肺结核患者的耐药情况,为本地区肺结核的诊治提供临床依据。方法 收集南京市第二医院2018年1月至2022年12月痰结核培养阳性并行菌种鉴定及药物敏感试验患者的临床资料,分析其耐药趋势及特征。结果 共纳入4824株临床分离菌株,包括人型结核分枝杆菌菌株3855株(79.91%)、牛型结核分枝杆菌菌株39株(0.81%)及非结核分枝杆菌菌株930株(19.28%)。3855株人型结核分枝杆菌菌株中,耐药菌株共1077株,总体耐药率为27.94%。其中利福平耐药462株(11.98%),耐多药218株(5.66%),多耐药201株(5.21%),广泛耐药41株(1.06%)。单因素分析显示,30岁≤年龄<60岁及复治是耐药相关危险因素。南京地区肺结核患者总体耐药率在2018—2021年呈缓慢上升趋势,2021年达峰值31.21%,2022年下降至25.56%;利福平耐药率稍有波动,2018-2020年稳定在11%~12%,2021年骤升至16.56%,2022年下降至10.31%。检测的9种抗结核药物中,人型结核分枝杆菌菌株的耐药顺位依次为异烟肼(16.78%)、链霉素(15.80%)、利福平(11.93%)、左氧氟沙星(8.87%)、乙胺丁醇(4.88%)、阿米卡星(1.79%)、卡那霉素(1.50%)、对氨基水杨酸(1.45%)及卷曲霉素(1.32%)。2018-2022年的耐药顺位相似,前5位均为异烟肼、链霉素、利福平、左氧氟沙星、乙胺丁醇及阿米卡星,二线注射用抗结核药阿米卡星、卷曲霉素及卡那霉素耐药率均较低。结论 2022年南京地区肺结核的防控取得一定成效,总体耐药率及利福平耐药率较2018-2021年下降。临床需重点关注青年男性及复治患者,根据药物敏感试验结果合理选择抗结核药物,减少耐药结核分枝杆菌的传播。
Objective To analyze the drug resistance of pulmonary tuberculosis patients in Nanjing during the past 5 years,and to provide clinical basis for the diagnosis and treatment of pulmonary tuberculosis.Method The clinical data of patients with positive sputum culture concurrent with bacterial species identification and drug susceptibility testing in Nanjing Second Hospital from January 2018 to December 2022 were collected,and their drug resistance trends and characteristics were analyzed.Result A total of 4824 clinical isolates were included,including:3855(79.91%)strains of human Mycobacterium tuberculosis,39(0.81%)Mycobacterium bovis strains and 930(19.28%)nontuberculous Mycobacterium strains.Among the 3855 strains of Mycobacterium tuberculosis,there were 1077 drug-resistant strains,and the overall drug resistance rate was 27.94%.Among them,462(11.98%)strains were resistant to rifampicin,and 218(5.66%)strains were multidrug-resistant.201(5.21%)strains were poly-resistant,and 41(1.06%)strains were extensively drug-resistant.Univariate analysis showed that age 30≤age<60 years and retreatment were risk factors for drug resistance.The overall drug resistance rate of tuberculosis patients in Nanjing area showed a slow rising trend in the preceding four years,reaching a peak of 31.21%in 2021,and decreasing to 25.56%in 2022.Rifampicin resistance rate fluctuated slightly,stabilizing at 11%-12%from 2018 to 2020,rising sharply to 16.56%in 2021,and decreasing to 10.31%in 2022.Among the nine anti-tuberculosis drugs tested,the sequence of drug resistance of Mycobacterium tuberculosis strains was:isoniazid(16.78%),streptomycin(15.80%),rifampicin(11.93%),levofloxacin(8.87%),ethambutol(4.88%),amikacin(1.79%),kanamycin(1.50%),para aminosalicylic acid(1.45%)and capreomycin(1.32%).The sequence of drug resistance during 2018-2022 was similar,with the top five being isoniazid,streptomycin,rifampicin,levofloxacin and ethambutol,and the drug resistance rates of the second-line injection anti-tuberculosis drugs amikacin,capreomycin and kanamycin were all lower.Conclusion In the period of 2022,the prevention and control of tuberculosis in Nanjing area achieved certain results,and the overall drug resistance rate and rifampicin resistance rate decreased compared with the rate of 2018-2021.It is necessary to pay special attention to young men and patients with retreatment,and rationally select anti-tuberculosis drugs according to drug susceptibility results to reduce the spread of drug-resistant mycobacterium tuberculosis.
作者
孔君
牛玉兰
黄艳
张向荣
Kong Jun;Niu Yulan;Huang Yan;Zhang Xiangrong(Department of Tuberculosis,the Second Hospital of Nanjing,Jiangsu Nanjing 211131,China)
出处
《新发传染病电子杂志》
2024年第1期17-20,共4页
Electronic Journal of Emerging Infectious Diseases
基金
“十三五”国家科技重大专项(2018ZX10725-509)。
关键词
结核分枝杆菌
非结核分枝杆菌
南京地区
耐药
流行状况
Mycobacterium tuberculosis
Nontuberculosis mycobacteria
Nanjing
Drug resistance
Prevalence
