Mandal A, Parthasarathy G, Burma S P, Sugunan A P, Vijayachari P
Technical Assistant, Regional Medical Research Centre (ICMR), P.B.No-13, Dollygunj, Port Blair 744 101, Andaman & Nicobar Islands, India.
Surg. CDR, JD (Pensions), DG AFMS Office, New Delhi, India.
Indian J Tuberc. 2015 Jan;62(1):23-8. doi: 10.1016/j.ijtb.2015.02.004. Epub 2015 Mar 7.
Drug resistance surveys have not yet conducted in these Islands and as such no data exists on drug resistance currently.
the present study was initiated with the objective of isolation and assessment of Drug resistance patterns of Mycobacterium tuberculosis isolates from sputum specimens collected from different categories of Tribal, Non-Tribal pulmonary tuberculosis patients treated under DOTS and Non-DOTS program by conventional culture and Proportion sensitivity (PST) method to detect patients with Multidrug resistant strains.
The investigation was hospital based laboratory surveillance study carried out for a period of 3 years at the selected hospitals of Andaman district (TB ward GB Pant Hospital at Port Blair, CHC Bamboflat at Port Blair and CHC Rangat at Rangat) and Nicobar district (CHC Nancowry at Nancowry groups of Islands), among the new cases and re-treatment cases of tuberculosis patient under DOTS program and Non-DOTS patients attended selected hospitals of Andaman & Nicobar districts chosen for the study.
83 culture positive isolates obtained (74 identified as M. tuberculosis) from the sputum specimen of 162 cases of tuberculosis patient by conventional culture method. 60 M. tuberculosis isolates subjected to drug susceptibility test using PST method, 7 patients (11.67%) found to be Multidrug resistant tuberculosis (MDR-TB), resistant patterns were S + H + R + E = 1(Cat II-DOTS),H + r = 3(Cat-I DOTS = 1, Cat II-DOTS-1,Non-DOTS = 1), Rifampicin resistant alone = 2 (Non-DOTS = 1, Cat II-DOTS = 1) and R + E = 1(Cat I-DOTS).
Laboratory finding suggested that nine MDR-TB strains detected in DOTS and Non-DOTS among 60 M. tuberculosis isolates were selected for drug susceptibility testing but two isolates detected as MDR-TB from patients was already on Second line drugs treatment were not included in the MDR-TB detection criteria. Hence 7 patients (11.67%) declared to be Multidrug resistant tuberculosis (MDR-TB). 2 MDR-TB strains with resistant patterns H + r = 1(Cat II-DOTS), Rifampicin resistant alone = 1(Non-DOTS) detected from 12 isolates of Tribal patients from Nicobar district and 5 MDR-TB strains with resistant patterns S + H + R + E = 1 (Cat II-DOTS), H + r = 2(Cat I-DOTS = 1,Non-DOTS = 1), Rifampicin resistant alone = 1 (Cat II-DOTS) and R + E = 1(Cat I-DOTS) detected from 48 isolates of Non-Tribal patients from Andaman district. To assess the MDR-TB burden in the islands, systematic drug resistant surveillance study needs to be conducted.
这些岛屿尚未开展耐药性调查，因此目前不存在关于耐药性的数据。
本研究旨在通过常规培养和比例敏感性（PST）方法，从不同类别的部落、非部落肺结核患者的痰标本中分离和评估结核分枝杆菌分离株的耐药模式，这些患者在直接观察下短程化疗（DOTS）和非DOTS项目中接受治疗，以检测耐多药菌株患者。
该调查是一项基于医院的实验室监测研究，在安达曼地区（布莱尔港的GB Pant医院结核病病房、布莱尔港的CHC Bamboflat和兰加特的CHC Rangat）和尼科巴地区（南科里群岛的CHC Nancowry）的选定医院进行，为期3年，研究对象为DOTS项目下的结核病新病例和复治病例以及在安达曼和尼科巴地区选定医院就诊的非DOTS患者。
通过常规培养方法，从162例肺结核患者的痰标本中获得83株培养阳性分离株（74株鉴定为结核分枝杆菌）。60株结核分枝杆菌分离株采用PST方法进行药敏试验，7例患者（11.67%）被发现为耐多药结核病（MDR-TB），耐药模式为S+H+R+E=1（类别II-DOTS），H+r=3（类别I DOTS=1，类别II-DOTS-1，非DOTS=1），仅对利福平耐药=2（非DOTS=1，类别II-DOTS=1），R+E=1（类别I DOTS）。
实验室结果表明，在60株结核分枝杆菌分离株中，从DOTS和非DOTS中检测出9株MDR-TB菌株进行药敏试验，但从患者中检测出的2株MDR-TB分离株已在接受二线药物治疗，未纳入MDR-TB检测标准。因此，7例患者（11.67%）被宣布为耐多药结核病（MDR-TB）。从尼科巴地区部落患者的12株分离株中检测出2株耐药模式为H+r=1（类别II-DOTS）、仅对利福平耐药=1（非DOTS）的MDR-TB菌株，从安达曼地区非部落患者的48株分离株中检测出5株耐药模式为S+H+R+E=1（类别II-DOTS）、H+r=2（类别I DOTS=1，非DOTS=1）、仅对利福平耐药=1（类别II-DOTS）和R+E=1（类别I DOTS）的MDR-TB菌株。为评估这些岛屿上的MDR-TB负担，需要进行系统的耐药监测研究。
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