张建民, 金莞尔, 杨瑞军. 浙江省衢州市结核分枝杆菌耐药监测调查[J]. 疾病监测, 2013, 28(4): 322-325. DOI: 10.3784/j.issn.1003-9961.2013.4.020
引用本文: 张建民, 金莞尔, 杨瑞军. 浙江省衢州市结核分枝杆菌耐药监测调查[J]. 疾病监测, 2013, 28(4): 322-325. DOI: 10.3784/j.issn.1003-9961.2013.4.020
ZHANG Jian-min, JIN Wan-er, YANG Rui-jun. Surveillance of drug-resistance of Mycobacterium tuberculosis in Quzhou, Zhejiang[J]. Disease Surveillance, 2013, 28(4): 322-325. DOI: 10.3784/j.issn.1003-9961.2013.4.020
Citation: ZHANG Jian-min, JIN Wan-er, YANG Rui-jun. Surveillance of drug-resistance of Mycobacterium tuberculosis in Quzhou, Zhejiang[J]. Disease Surveillance, 2013, 28(4): 322-325. DOI: 10.3784/j.issn.1003-9961.2013.4.020

浙江省衢州市结核分枝杆菌耐药监测调查

Surveillance of drug-resistance of Mycobacterium tuberculosis in Quzhou, Zhejiang

  • 摘要: 目的 了解浙江省衢州市结核分枝杆菌临床分离株耐药状况, 为结核病的防治提供参考依据。 方法 收集2010年全年衢州4县2区6家医院肺结核就诊病例痰标本,用改良罗氏培养基进行病原分离,鉴别培养基培养法进行菌型鉴定。对分离到的结核分枝杆菌采用比例法对4种一线抗结核药物,异烟肼(INH)、利福平(RFP)、链霉素(SM)、乙胺丁醇(EMB),和二线抗结核药物氧氟沙星(OFX)、卡那霉素(KM)进行药物敏感性检测,用 SPSS 11.0统计软件进行统计分析。 结果 371 株结核分枝杆菌对4种一线抗结核药物,INH、RFP、SM和 EMB全部敏感的菌株为292株(78.71%),对二线抗结核药物OFX和KM全部敏感的菌株为337株(90.84%);耐药菌株89株(23.99%),其中,单耐药菌株51株(13.75%),耐多药菌株21株(5.66%),多耐药株14株(3.77%),广泛耐药株3株(0.81%)。结核分枝杆菌对4种一线药物INH、RFP、SM和 EMB的耐药率分别为15.36%(57/371)、7.01%(26/371)、11.86%(44/371)和3.23%(12/371);对2种二线药物OFX和KM的耐药率分别为7.82%(29/371) 和2.42%(9/371)。326例初治患者的耐药率为INH 10.12%(33/326)、RFP 2.45%(8/326)、SM 8.90%(29/326)、EMB 1.23%(4/326)、OFX 3.68%(12/326)、KM 1.53%(5/326),非耐药80.98%(264/326),耐多药1.84%(6/326);45例复治患者的耐药率为INH 53.33%(24/45)、RFP 40.00%(18/45)、SM 33.33%(15/45)、EMB 17.78%(8/45)、OFX 37.78%(17/45)、KM 8.89%(4/45),非耐药40.00%(18/45),耐多药33.33%(15/45)。 结论 衢州市结核分枝杆菌的耐药情况较为严重,每种药物复治患者的耐药率均明显高于初治患者,在制定结核病防控策略时应给予充分重视,同时进一步加强高质量的全程监督短程化疗。

     

    Abstract: Objective To understand the drug resistance of clinical isolated Mycobacterium tuberculosis in Quzhou, Zhejiang province, and provide evidence for the prevention and treatment of tuberculosis.Methods The clinical strains isolated in 6 hospitals in Quzhou in 2010 were identified by differential medium culture method. The drug susceptibility of M. tuberculosis strains was detected with proportion method.Results Among 371 clinical isolated M. tuberculosis strains, 292(78.71%) were sensitive to four first line anti TB drugs(isoniazid, rifampicin, streptomycin and ethambutol), and 337(90.84%) were sensitive to two second line anti TB drugs(ofloxacin, and kanamycin). Among 89 drug resistant strains, 51(13.75%) were single drug resistant, 14(3.77%) were poly-resistant, 21(5.66%) were multidrug resistant and 3(0.81%) were extensive drug resistant. The resistant rate to isoniazid, rifampicin, streptomycin, ethambutol, ofloxacin and kanamycin was 15.36%, 7.01%, 11.86%, 3.23%, 7.82% and 2.42% respectively. Among 326 patients receiving initial treatment, the resistant rate to isoniazid, rifampicin, streptomycin, ethambutol, ofloxacin and kanamycina was 10.12%, 2.45%, 8.90%, 1.23%, 3.68% and 1.53% respectively, The non drug resistant and MDR rates were 80.98% and 1.84%. Among 45 patients receiving re-treatment, the resistant rate to isoniazid, rifampicin, streptomycin, ethambutol, ofloxacin and kanamycin was 53.33%, 40.00%, 33.33%, 17.78%, 37.78% and 8.89% respectively, and the non drug resistant and MDR rates were 40.00% and 33.33%.Conclusion The drug resistance of the clinical isolated M. tuberculosis strains in Quzhou was very serious, and the drug resistant rate was higher in the patients receiving retreatment than in the patients receiving initial treatment, to which close attention should be paid. It is necessary to enhance the implementation of DOTS strategy.

     

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