Department of Intensive Care Medicine, Chi-Mei Medical Center, Liouying, Tainan, Taiwan.
Int J Antimicrob Agents. 2011 Aug;38(2):125-9. doi: 10.1016/j.ijantimicag.2011.03.016. Epub 2011 May 17.
Few studies have investigated the drug resistance profiles of Mycobacterium tuberculosis (MTB) isolates recovered from different sites of infection. A total of 4521 non-duplicate MTB isolates, including 3723 (82.3%) from respiratory specimens and 798 (17.7%) from non-respiratory sources, were recovered from patients treated at a medical centre in Taiwan from 2000 to 2010. Trend analysis showed a significant decrease (P<0.05) in the rates of resistance to isoniazid, rifampicin and ethambutol, a decrease in resistance to any one of four agents, namely isoniazid, rifampicin, ethambutol or streptomycin, and a decrease in resistance to both isoniazid and rifampicin (multidrug resistance) amongst pulmonary MTB isolates. A similar decrease in resistance to isoniazid and ethambutol was noted amongst non-pulmonary isolates. Rates of drug resistance were significantly higher amongst MTB isolates recovered from respiratory specimens than amongst those from non-respiratory specimens to 0.2 μg/mL isoniazid (15.3% vs. 9.4%; P<0.0001), 1 μg/mL rifampicin (5.5% vs. 3.3%; P=0.0108), 5 μg/mL ethambutol (7.3% vs. 3.8%; P=0.0004), and both isoniazid and rifampicin (4.8% vs. 2.5%; P=0.0051). Resistance rates amongst isolates causing tuberculous lymphadenitis were significantly lower than amongst those causing genitourinary tuberculosis (TB) to isoniazid (3.5% vs. 19.4%, P=0.0012) and to isoniazid, rifampicin, ethambutol or streptomycin (9.6% vs. 22.6%, P=0.0003). In conclusion, the rates of resistance to first-line anti-TB agents and to multiple agents differed amongst MTB isolates obtained from different infectious sources. Continuous monitoring of resistance of MTB isolates from various sites is necessary in order to establish an effective TB surveillance programme.
从不同感染部位分离的结核分枝杆菌（MTB）分离株的耐药谱特征，鲜有研究报道。2000 年至 2010 年，从台湾一家医疗中心治疗的患者中，共分离出 4521 例非重复 MTB 分离株，其中 3723 例（82.3%）来自呼吸道标本，798 例（17.7%）来自非呼吸道来源。趋势分析显示，对异烟肼、利福平及乙胺丁醇的耐药率显著下降（P<0.05），对异烟肼、利福平、乙胺丁醇或链霉素中的任何一种药物耐药率下降，对异烟肼和利福平同时耐药率（耐多药）下降，这些变化在肺部 MTB 分离株中尤为明显。非肺部分离株中也观察到异烟肼和乙胺丁醇耐药率相似的下降。与非呼吸道标本相比，呼吸道标本中 MTB 分离株对异烟肼和乙胺丁醇的耐药率显著更高（0.2μg/mL 异烟肼为 15.3% vs. 9.4%；P<0.0001）、1μg/mL 利福平为 5.5% vs. 3.3%（P=0.0108）、5μg/mL 乙胺丁醇为 7.3% vs. 3.8%（P=0.0004）、异烟肼和利福平均为 4.8% vs. 2.5%（P=0.0051）。结核性淋巴结炎分离株的耐药率显著低于泌尿生殖系统结核（TB）（异烟肼为 3.5% vs. 19.4%，P=0.0012）和异烟肼、利福平、乙胺丁醇或链霉素（9.6% vs. 22.6%，P=0.0003）。总之，从不同感染源获得的 MTB 分离株对一线抗结核药物和多种药物的耐药率不同。为了建立有效的结核病监测计划，有必要对来自不同部位的 MTB 分离株的耐药性进行持续监测。
