结核分枝杆菌临床株对利福霉素类药物的耐药特点分析

目的比较分析临床标本结核分枝杆菌(Mycobacterium tuberculosis,Mtb)对利福霉素类药物的耐药特点,为含利福霉素类药物的抗结核治疗方案的改进提供细菌学基础。方法用绝对浓度法检测470份临床标本中Mtb的耐药情况。结果 180份培养阳性的标本中,41份对利福霉素类耐药,对利福平和利福喷汀的耐药水平高度一致,对二者的耐药水平显著高于对利福布汀的耐药水平,对低浓度和高浓度利福布汀耐药的数量差异显著。结论临床标本中的Mtb对利福平和利福喷汀的耐药水平表现出高度一致性,提示利福喷汀不适于作为利福平耐药的后备药物,利福布汀可以作为利福平的后备药物,但服用剂量可能影响治疗效果。

Characteristics of resistance of Mycobacterium tuberculosis to rifamycins in clinical isolates

Objective To provide the bacteriological basis for improving the use of rifamycins by analyzing the characteristics of resistance of clinically isolated Mycobacterium tuberculosis (Mtb) to rifamycins. Methods Absolute concentration method was per-formed to detect resistance of Mtb in 470 clinical isolates. Results Of 180 samples positive for Mtb, 41 were resistant to rifamycins. The resistance levels of Mtb in clinical isolates to rifampicin and rifapentine were highly consistent, and they were significantly higher than that to rifabutin. The numbers of samples with resistance of Mtb to rifabutin at a low concentration were significantly different from those to rifabutin at a high concentration. Conclusions The result that the resistance of Mtb to rifampicin is highly consistent with that to rifapentine suggests that rifapentine should not be suitable to replace rifampicin after Mtb is resistant to rifampicin;rifabutin should be able to replace rifampicin, but the dose of rifabutin may affect the therapeutic efficacy.