Kumar P, Kumar P, Balooni V, Singh S
Division of Clinical Microbiology and Molecular Medicine, Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India.
Int J Tuberc Lung Dis. 2015 Apr;19(4):434-9. doi: 10.5588/ijtld.14.0596.
Effective tuberculosis (TB) control has been hindered by the emergence of multidrug-resistant TB (MDR-TB).
To analyse the frequency of drug resistance among presumed cases of drug-resistant TB in the state of Punjab, India, and to determine the frequency of various genetic mutations detected using the line-probe assay (LPA).
Eight hundred patients with presumptive drug-resistant TB were enrolled under the programmatic management of drug-resistant TB under India's Revised National Tuberculosis Control Programme. Sputum samples from these patients were subjected to smear microscopy and LPA. Clinicodemographic details along with drug resistance patterns and genetic mutations were studied.
After excluding non-eligible samples, 545 samples were analysed, of which 290 (53.2%) showed resistance. Isoniazid and rifampicin (RMP) monoresistance were detected in respectively 9.3% (51/545) and 18% (98/545) of samples, while MDR was present in 25.8% (141/545) of samples. Of the MDR-TB cases, 2.1% (3/141) were treatment-naïve, while 90.8% (128/141) were on retreatment. The most common mutation conferring RMP resistance was S531L.
All patients undergoing retreatment for TB should be tested for drug susceptibility at the initial evaluation. Factors responsible for high MDR-TB and heteroresistance in Punjab need further studies.
耐多药结核病（MDR-TB）的出现阻碍了有效的结核病（TB）控制。
分析印度旁遮普邦疑似耐药结核病病例中的耐药频率，并确定使用线性探针测定法（LPA）检测到的各种基因突变的频率。
在印度修订的国家结核病控制规划下的耐药结核病规划管理中，纳入了800例疑似耐药结核病患者。对这些患者的痰液样本进行涂片显微镜检查和LPA。研究了临床人口统计学细节以及耐药模式和基因突变。
排除不合格样本后，分析了545份样本，其中290份（53.2%）显示耐药。分别在9.3%（51/545）和18%（98/545）的样本中检测到异烟肼和利福平（RMP）单耐药，而25.8%（141/545）的样本中存在耐多药。在耐多药结核病病例中，2.1%（3/141）为初治患者，而90.8%（128/141）为复治患者。导致利福平耐药的最常见突变是S531L。
所有接受结核病复治的患者在初始评估时都应进行药敏试验。旁遮普邦耐多药结核病和异质性耐药率高的相关因素需要进一步研究。
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