Rastogi N, Ross B C, Dwyer B, Goh K S, Clavel-Sérès S, Jeantils V, Cruaud P
Unité de la Tuberculose et des Mycobactéries, Institut Pasteur, Paris, France.
Eur J Clin Microbiol Infect Dis. 1992 Oct;11(10):901-7. doi: 10.1007/BF01962370.
Serial isolates of Mycobacterium tuberculosis were cultured from a patient who failed to respond to standard antituberculous chemotherapy. Isolates were cultured in March 1989, July 1989, December 1989 and May 1990. Each successive isolate was found to be resistant to a wider range of antituberculous drugs than its predecessors. The initial isolate was resistant to isoniazid and rifampin, the second isolate was also resistant to ethambutol, the third was also resistant to pyrazinamide, ansamycin (= rifabutin) and ofloxacin and the last isolate was also resistant to ciprofloxacin and sparfloxacin. All four isolates' bacteriophage typing profiles and DNA restriction fragment patterns determined by Southern blot hybridization using the IS6110/IS986 probes and the new probe pTBN12 were concordant. It was concluded that this patient was persistently infected with a single strain of Mycobacterium tuberculosis which developed resistance to a number of families of drugs but did not show any significant change in typing patterns. The problem of acquired multiple drug resistance, particularly to fluoroquinolones and rifamycins, represents a new challenge in tuberculosis therapy.
从一名对标准抗结核化疗无反应的患者身上培养出结核分枝杆菌的系列分离株。分离株分别于1989年3月、1989年7月、1989年12月和1990年5月培养。结果发现，每一个后续分离株都比其前一个分离株对更广泛的抗结核药物耐药。最初的分离株对异烟肼和利福平耐药，第二个分离株还对乙胺丁醇耐药，第三个分离株还对吡嗪酰胺、安莎霉素（=利福布汀）和氧氟沙星耐药，最后一个分离株还对环丙沙星和司帕沙星耐药。使用IS6110/IS986探针和新探针pTBN12通过Southern印迹杂交确定的所有四个分离株的噬菌体分型谱和DNA限制性片段模式均一致。得出的结论是，该患者持续感染单一菌株的结核分枝杆菌，该菌株对多种药物家族产生耐药性，但分型模式未显示任何显著变化。获得性多重耐药问题，尤其是对氟喹诺酮类和利福霉素类的耐药，是结核病治疗中的一个新挑战。
