海南省三亚市2013-2015年肺结核患者耐药状况

目的 了解三亚市结核分支杆菌耐药情况,为今后结核病防治策略提供参考依据.方法 对三亚市2013年11月-2015年12月确诊登记的涂阳肺结核患者痰标本进行分离培养,对经鉴定为结核分支杆菌的菌株进行异烟肼(H)、利福平(R)、乙胺丁醇(E)、链霉素(S)、氧氟沙星(Ofx)和卡那霉素(Km)等6种抗结核药物敏感性试验. 结果 276例肺结核患者痰标本培养阳性252例,经菌型鉴定249株(初治216例,复治33例)为结核分枝杆菌,其中耐药51株,总耐药率为20.48％,初治及复治患者总耐药率分别为18.06％、36.36％;耐多药14株,耐多药率为5.62％,初治及复治患者耐多药率分别为4.63％、12.12％.单耐药29例,单耐药率为11.65％,多耐药8例,多耐药率为3.21％;任何耐药顺位是S(11.24％)、H(10.04％)、R(7.63％)、Ofx(5.22％)、E(0％)、Km(0％);初、复治患者耐药率差异有统计学意义(P＜0.05).结论 三亚市结核病耐药情况低于全国平均水平,但需要进一步加强初治和复治肺结核患者治疗管理,以减少耐药结核病的发生.

Status of drug resistance of pulmonary tuberculosis patients in Sanya,Hainan, 2013-2015

Objective To understand the drug resistance of Mycobacterium tuberculosis in Sanya City,so as to provide the reference for formulating the strategy of prevention and control of tuberculosis (TB).Methods The sputum samples were collected,isolated and cultured from the sputum smear positive patients with pulmonary TB in Sanya City from November 2013 to December 2015,and the drug susceptibility tests of M.tuberculosis to 6 anti-TB drugs [isoniazid (H),rifampicin (R),ethambutol (E),streptomycin (S),ofloxacin (Ofx) and kanamycin (Km)] were performed.Results Totally 252 of 276 sputum specimens were cultured positive,and 249 strains were identified as M.tuberculosis.A total of 51 bacterial strains were tested drug resistance,the total rate of drug resistance was 20.48％,and the rates of drug resistance of the initial and re-treatment patients were 18.06％ and 36.36％ respectively.Totally 14 bacterial strains were tested multi-drug resistance,the rate of multidrug resistance was 5.62％,and the rates of multi-drug resistance of the initial and re-treatment patients were 4.63％ and 12.12％ respectively.Totally 29 bacterial strains were tested mono-resistance and the rate were 11.65％,and 8 bacterial strains were tested poly-resistance and the rate were 3.21％.The anti-tuberculosis drugs were sorted from the high to low as follow:S (11.24％),H (10.04％),R (7.63％),Ofx (5.22％),E (0％),and Km (0％).There were a statistical significant difference between the drug resistance rate of the primary patients and that of the re-treatment patients.Conclusion The drug resistance rate of pulmonary tuberculosis in Sanya City is below the national average level.However,the care management of primary and retreatment tuberculosis patients is still required to be further strengthened so as to decrease the rate of anti-drug tuberculosis.