[氧氟沙星和左氧氟沙星对结核分枝杆菌耐药断点定义的初步研究]

[A preliminary study on the definition of resistant breakpoints of ofloxacin and levofloxacin for Mycobacterium tuberculosis].

作者信息

Huang Xue-rui, Gao Wei-wei, Zhang Xu-xia, Wang Su-min, Pan Yu-xuan, Ma Yu

机构信息

Tuberculous Department. Beijing Tuberculosis and Thoracic Tumor Institute, Beijing 101149, China.

出版信息

Zhonghua Jie He He Hu Xi Za Zhi. 2004 Feb;27(2):84-8.

PMID:14990180

Abstract

OBJECTIVE

To test the MIC of ofloxacin and levofloxacin (MIC(F) and MIC(V)) in 101 strains of Mycobacterium tuberculosis (M. tb) isolated from patients with active tuberculosis and to analyze the relation between MIC and past history of fluoroquinolones (FQs) administration. And according to the analysis of the therapeutic effect of the regimen including FQs, we want to define the resistant breakpoints of OFLX and LVFX clinically.

METHOD

All isolates from sputa or pus obtained from in-patients in our hospital from Jan 1999 to Sept 2000 were tested for MIC and susceptibility. 47 patients with pulmonary tuberculosis received regimens including FQs were observed consecutively. Chi-square test was applied for the statistical analysis.

RESULT

(1) The MIC(V) of 96% clinical isolates tested were 2 times lower than MIC(F). (2) The MIC(F) < 8 microg/ml and MIC(V) < 4 microg/ml were found among 91% and 92% patients without previous FQs administration, while only the MIC(F) > or = 8 microg/ml and MIC(V) > or = 4 microg/ml were found among 54% and 57% for the patients with FQs administration history. (3) If MIC(F) > or = 8 microg/ml and MIC(V) > or = 4 microg/ml were defined as the clinical resistant breakpoints, in susceptible group, the sputum negative conversion rates were 54%, 75% and 82% respectively after receiving the regimens including FQs in 3, 6, and 12 months, while 16%, 32%, and 42% respectively in resistant group, (P < 0.01). Also, there were significant differences between these two groups for chest X-ray improvements after 12 months' treatment, (P < 0.01). There were significant differences for sputum conversion rates and chest X-ray improvement between MIC(V) < 4 microg/ml and MIC(V) > or = 4 microg/ml groups (P < 0.01).

CONCLUSIONS

According to the evaluation for the therapeutic effects of regimens including FQs, it is suggested that MIC(F) > or = 8 microg/ml and MIC(V) > or = 4 microg/ml be defined as resistant breakpoints clinically. The emergence of resistance to FQs in patients with tuberculosis can influence the therapeutic effects.

摘要

目的

检测从活动性肺结核患者中分离出的101株结核分枝杆菌的氧氟沙星和左氧氟沙星的最低抑菌浓度（MIC(F)和MIC(V)），并分析MIC与既往氟喹诺酮类（FQs）用药史之间的关系。通过对含FQs方案治疗效果的分析，临床确定OFLX和LVFX的耐药断点。

方法

对1999年1月至2000年9月我院住院患者痰液或脓液中的所有分离菌株进行MIC和药敏试验。连续观察47例接受含FQs方案治疗的肺结核患者。采用卡方检验进行统计分析。

结果

（1）96%的临床分离株的MIC(V)比MIC(F)低2倍。（2）既往未使用FQs的患者中，91%和92%的患者MIC(F)<8μg/ml且MIC(V)<4μg/ml，而有FQs用药史的患者中，分别有54%和57%的患者MIC(F)≥8μg/ml且MIC(V)≥4μg/ml。（3）若将MIC(F)≥8μg/ml且MIC(V)≥4μg/ml定义为临床耐药断点，在敏感组中，接受含FQs方案治疗3、6和12个月后痰菌阴转率分别为54%、75%和82%，而耐药组分别为16%、32%和42%，（P<0.01）。治疗12个月后两组胸部X线改善情况也有显著差异，（P<0.01）。MIC(V)<4μg/ml组和MIC(V)≥4μg/ml组之间痰菌阴转率和胸部X线改善情况有显著差异（P<0.01）。