[2000 - 2006年巴西南马托格罗索州结核分枝杆菌的耐药情况]

[Drug resistance profile of Mycobacterium tuberculosis in the state of Mato Grosso do Sul, Brazil, 2000-2006].

作者信息

Marques Marli, Cunha Eunice Atsuko Totumi, Ruffino-Netto Antonio, Andrade Sonia Maria de Oliveira

机构信息

Programa Estadual de Controle da Tuberculose, Secretaria de Estado da Saúde de Mato Grosso do Sul, Campo Grande, MS, Brasil.

出版信息

J Bras Pneumol. 2010 Mar-Apr;36(2):224-31. doi: 10.1590/s1806-37132010000200011.

DOI:10.1590/s1806-37132010000200011

PMID:20485944

Abstract

OBJECTIVE

To determine the drug resistance profile of Mycobacterium tuberculosis in the state of Mato Grosso do Sul, Brazil, between 2000 and 2006.

METHODS

Descriptive study of reported tuberculosis cases in the Brazilian Case Registry Database. We included only those cases in which M. tuberculosis culture was positive and sensitivity to drugs (rifampicin, isoniazid, streptomycin and ethambutol) was tested. Löwenstein-Jensen and Ogawa-Kudoh solid media were used for cultures, as was an automated liquid medium system. Sensitivity tests were based on the proportion method.

RESULTS

Among the 783 cases evaluated, males predominated (69.7%), as did patients in the 20-49 year age bracket (70%), a diagnosis of pulmonary tuberculosis (94.4%) and positive HIV serology (8.6%); 645 (82.4%) were new cases, and 138 (17.6%) had previously been treated. Resistance to at least one drug was found in 143 cases (18.3%). The primary resistance (PR) rate was, respectively, 8.1%, 1.6%, 2.8% and 12.4%, for monoresistance, multidrug resistance (MDR), other patterns of resistance and resistance to at least one drug, whereas the acquired resistance (AR) rate was 14.5%, 20.3%, 10.9% and 45.7%, respectively, and the combined resistance (CR) rate was 9.2%, 4.9%, 4.2% and 18.3%, respectively. In PR, streptomycin was the most common drug, whereas isoniazid was the most common in AR and CR (7.2% and 3.7%, respectively).

CONCLUSIONS

These high levels of resistance undermine the efforts for tuberculosis control in Mato Grosso do Sul. Acquired MDR was 12.7 times more common than was primary MDR, demonstrating that the previous use of drug therapy is an indicator of resistance. These levels reflect the poor quality of the health care provided to these patients, showing the importance of using the directly observed treatment, short course strategy, as well as the need to perform cultures and sensitivity tests for the early diagnosis of drug resistance.

摘要

目的

确定2000年至2006年间巴西南马托格罗索州结核分枝杆菌的耐药情况。

方法

对巴西病例登记数据库中报告的结核病病例进行描述性研究。我们仅纳入结核分枝杆菌培养阳性且对药物（利福平、异烟肼、链霉素和乙胺丁醇）进行药敏试验的病例。采用罗-琴固体培养基和小川-久藤固体培养基进行培养，同时也使用了自动化液体培养基系统。药敏试验基于比例法。

结果

在评估的783例病例中，男性占主导（69.7%），20至49岁年龄段的患者占主导（70%），肺结核诊断占比（94.4%），HIV血清学检测阳性占比（8.6%）；645例（82.4%）为新发病例，138例（17.6%）曾接受过治疗。143例（18.3%）发现对至少一种药物耐药。单耐药、多耐药（MDR）、其他耐药模式以及对至少一种药物耐药的原发性耐药（PR）率分别为8.1%、1.6%、2.8%和12.4%，而获得性耐药（AR）率分别为14.5%、20.3%、10.9%和45.7%，合并耐药（CR）率分别为9.2%、4.9%、4.2%和18.3%。在原发性耐药中，链霉素是最常见的耐药药物，而在获得性耐药和合并耐药中异烟肼是最常见的耐药药物（分别为7.2%和3.7%）。