Shen Xin, Li Jing, Gao Qian, Xu Biao, Mei Jian
Department of TB Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China.
Zhonghua Jie He He Hu Xi Za Zhi. 2011 Jun;34(6):451-3.
To determine the pattern of resistance to second-line drugs (SLDs) in patients with tuberculosis (TB) in Shanghai, China.
All sputum culture positive patients detected at each district/county TB hospital/clinic in Shanghai during January to December 2009 were enrolled. First-line drug susceptibility testing was routinely performed for each clinical isolate. All clinical isolates with any resistance to first-line anti-TB drug were tested for second-line drug susceptibility.
Of the 431 TB patients with any resistance to first-line anti-TB drugs included in this study, 27.8% (120/431) were resistant to any SLDs tested. The rank of drug resistance was as follows: ofloxacin (68/431, 15.8%) > kanamycin (37/431, 8.6%) > para-aminosalicylic acid (35/431, 8.1%) > capreomycin (28/431, 6.5%) > amikacin (23/431, 5.3%) > prothionamide (8/431, 1.9%). Mono-resistance to SLD was the most predominant pattern. Among patients with resistance to SLD, the percentages of mono-resistance were 2/2, 20/36, 22/24 and 43/58 for rifampin-resistant group, isoniazid-resistant group, other-resistant group, and MDR group, respectively.
The high prevalence of resistance to SLDs in TB patients suggests the necessity to strengthen the TB control program for drug-resistant TB in Shanghai.
确定中国上海结核病患者对二线药物（SLD）的耐药模式。
纳入2009年1月至12月期间在上海各区县结核病医院/诊所检测出的所有痰培养阳性患者。对每个临床分离株常规进行一线药物敏感性检测。对所有对一线抗结核药物有任何耐药性的临床分离株进行二线药物敏感性检测。
本研究纳入的431例对一线抗结核药物有任何耐药性的结核病患者中，27.8%（120/431）对所检测的任何一种二线药物耐药。耐药药物排名如下：氧氟沙星（68/431，15.8%）>卡那霉素（37/431，8.6%）>对氨基水杨酸（35/431，8.1%）>卷曲霉素（28/431，6.5%）>阿米卡星（23/431，5.3%）>丙硫异烟胺（8/431，1.9%）。对二线药物的单耐药是最主要的模式。在对二线药物耐药的患者中，利福平耐药组、异烟肼耐药组、其他耐药组和耐多药组的单耐药百分比分别为2/2、20/36、22/24和43/58。
结核病患者对二线药物的高耐药率表明有必要加强上海耐药结核病的防控计划。
