Kazumi Yuko, Itagaki Nobunori, Ohmori Masako, Wada Masako, Hoshino Hitoshi, Mitarai Satoshi, Sugawara Isamu, Ishikawa Nobukatsu, Mori Toru
Pathology Division, Mycobacterium Reference Center, Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo.
Kekkaku. 2007 Dec;82(12):891-6.
To observe the frequency of MDR-TB/XDR-TB strains isolated from chronic pulmonary tuberculosis patients in Japan.
Ad hoc National Tuberculosis Survey 2000 on frequency of MDR-TB and XDR-TB strains.
Four hundred and thirty four clinical isolates were collected by the Ad hoc National Tuberculosis Survey 2000, the drug susceptibility testings (proportion method, MGIT Middlebrook, and BrothMIC NTM) were conducted on these strains. These clinical isolates were obtained from patients registered at Health Centers in Japan by the end of 1999 who were culture-positive in 1999 and were registered before January 1st, 1998. The isolates used in this study were selected from patients who were culture-positive at shortest 2 years after the registration.
The clinical isolates resistant to both INH and RFP were 321 out of 434 (74.0%). The 180 MDR-resistant clinical isolates were also resistant to levofloxacin and amikacin and/or kanamycin. These phenotypes are XDR-TB. No previously registered cases were 165, and previously registered cases were 143 and unknown cases were 13 out of 321 MDR-TB. In 180 XDR-TB cases, no previously registered cases were 95, previously registered cases were 78 and unknown cases were 7. In no previously registered cases, more than 50% cases started treatment in 1990s. Approximately 50% of previously registered patients started treatment in 1960s and 1970s.
We performed drug susceptibility testing for 434 clinical isolates which were culture-positive at shortest 2 years after registration. No. of MDR-TB patients was 321 and that of XDR-TB patients was 180. The treatment outcome of these patients have to be followed up carefully at Health Centers. The frequency of amikacin resistance was relatively high. This may be due to either common use of amikacin or cross-resistance against streptomycin and kanamycin.
观察从日本慢性肺结核患者中分离出的耐多药结核/广泛耐药结核菌株的频率。
2000年全国结核病专项调查中耐多药结核和广泛耐药结核菌株的频率。
通过2000年全国结核病专项调查收集了434株临床分离株，并对这些菌株进行了药敏试验（比例法、MGIT Middlebrook法和肉汤微量稀释法检测非结核分枝杆菌）。这些临床分离株来自1999年底在日本保健中心登记的患者，这些患者在1999年培养呈阳性且在1998年1月1日前登记。本研究中使用的分离株选自登记后至少2年培养呈阳性的患者。
434株临床分离株中，对异烟肼和利福平均耐药的有321株（74.0%）。180株耐多药临床分离株对左氧氟沙星和阿米卡星及/或卡那霉素也耐药。这些表型为广泛耐药结核。在321例耐多药结核中，既往未登记病例165例，既往已登记病例143例，不明病例13例。在180例广泛耐药结核病例中，既往未登记病例95例，既往已登记病例78例，不明病例7例。在既往未登记病例中，超过50%的病例在20世纪90年代开始治疗。约50%的既往已登记患者在20世纪60年代和70年代开始治疗。
我们对登记后至少2年培养呈阳性的434株临床分离株进行了药敏试验。耐多药结核患者321例，广泛耐药结核患者180例。保健中心必须密切随访这些患者的治疗结果。阿米卡星耐药频率相对较高。这可能是由于阿米卡星的普遍使用或对链霉素和卡那霉素的交叉耐药所致。
