[捷克共和国的多重耐药结核病（1999 - 2001年）]

[Multiresistant tuberculosis in the Czech Republic (1999-2001)].

作者信息

Havelková M, Hyncicová-Zemanová I, Príkazský V, Slosárek M, Janota J

机构信息

Centrum epidemiologie a mikrobiologie, Odborná skupina mykobakteriálních infekcí a NRLM SZU, Praha.

出版信息

Cas Lek Cesk. 2003;142(6):356-64.

PMID:12924035

Abstract

BACKGROUND

Multidrug-resistant (MDR) tuberculosis, defined as a disease caused by Mycobacterium tuberculosis strains, which are resistant to more antituberculous drugs (at least to isoniazid and rifampicin), is a problem frequently discussed in the Czech Republic. Cases of specific disease refractive to causal antituberculous therapy are associated with the risk of the spread of the causative agent among the population.

METHODS AND RESULTS

The National Reference Laboratory for Mycobacteria collected 2813 Mycobacterium tuberculosis strains isolated by Czech mycobacteriological laboratories in 1999 to 2001. All strains were tested for susceptibility to basic antituberculous drugs and then the MDR strains were further tested for susceptibility/resistance to other antituberculous and antibacterial drugs. The MDR strains were studied by DNA analysis (DNA fingerprinting restriction analysis, RFLP-Restriction Fragment Length Polymorphism) as well. Thirty-nine patients who had MDR tuberculosis were excretors of 56 Mycobacterium tuberculosis strains. In average, MDR tuberculosis accounted for 1.96% (1.7-2.4) of all cases of bacillary tuberculosis. The most frequent type of the multidrug resistance was that resistant to four basic antituberculous drugs (isoniazid, rifampicin, ethambutol and streptomycin). It was confirmed in 48.2% multidrug resistant strains.

CONCLUSIONS

Isepamicin, clofazimin, capreomycin and amikacin are considered to be the most promising antituberculosis drugs. Based on RFLP profiles, 61.5% of strains were placed into 8 clusters while the other strains remained unclustered. No significant differences in geographical distribution and population structure were found between the excretors of clustered strains and those of unclustered strains. Preliminary comparison with restriction profiles of the MDR Mycobacterium tuberculosis strains in the international database suggests the uniqueness of Czech strains showing the profiles not found elsewhere to date.

摘要

背景

耐多药（MDR）结核病是由结核分枝杆菌菌株引起的疾病，这些菌株对多种抗结核药物耐药（至少对异烟肼和利福平耐药），这是捷克共和国经常讨论的一个问题。对病因性抗结核治疗有抗药性的特定疾病病例与病原体在人群中传播的风险相关。

方法与结果

分枝杆菌国家参考实验室收集了1999年至2001年捷克分枝杆菌实验室分离出的2813株结核分枝杆菌菌株。所有菌株都进行了对基本抗结核药物的敏感性测试，然后对耐多药菌株进一步测试对其他抗结核和抗菌药物的敏感性/耐药性。耐多药菌株也通过DNA分析（DNA指纹限制性分析，RFLP-限制性片段长度多态性）进行了研究。39例耐多药结核病患者排出了56株结核分枝杆菌菌株。耐多药结核病平均占所有细菌性结核病例的1.96%（1.7 - 2.4）。最常见的耐多药类型是对四种基本抗结核药物（异烟肼、利福平、乙胺丁醇和链霉素）耐药。在48.2%的耐多药菌株中得到证实。

结论

异帕米星、氯法齐明、卷曲霉素和阿米卡星被认为是最有前景的抗结核药物。根据RFLP图谱，61.5%的菌株被归入8个簇，而其他菌株仍未聚类。在聚类菌株排出者和未聚类菌株排出者之间，未发现地理分布和人群结构的显著差异。与国际数据库中耐多药结核分枝杆菌菌株的限制性图谱进行的初步比较表明，捷克菌株具有独特性，其图谱迄今在其他地方尚未发现。