印度胸内结核患儿原发性耐药的高流行率。

High prevalence of primary drug resistance in children with intrathoracic tuberculosis in India.

作者信息

Prajapati Suneel, Upadhyay Kriti, Mukherjee Aparna, Kabra S K, Lodha Rakesh, Singh Varinder, Grewal Harleen M S, Singh Sarman

机构信息

a Division of Clinical Microbiology and Molecular Medicine , Department of Laboratory Medicine.

b Department of Paediatrics , All India Institute of Medical Sciences.

出版信息

Paediatr Int Child Health. 2016 Aug;36(3):214-8. doi: 10.1179/2046905515Y.0000000041.

DOI:10.1179/2046905515Y.0000000041

PMID:26052730

Abstract

BACKGROUND

Drug susceptibility testing (DST) of Mycobacterium tuberculosis (Mtb) isolates is crucial for the effective treatment of tuberculosis. Data on DST patterns in Mtb isolates in childhood tuberculosis are scanty.

AIMS

To determine drug resistance patterns in Mtb isolates from a paediatric TB cohort in North India.

METHODS

403 children aged 6 months to14 year with probable intrathoracic tuberculosis were enrolled prospectively. All were treatment-naïve. 802 ambulatory-induced sputa (IS) and 787 gastric aspirate (GA) samples were cultured in BACTEC-MGIT960 system, and DST of the Mtb isolates was undertaken using the automated BACTEC-MGIT960 SIRE kit.

RESULTS

Of the 403 children, 147 (36.4%) were culture-confirmed: 132 (89.8%) isolates were Mtb and 15 (10.2%) non-tuberculous mycobacteria (NTM). Five Mtb isolates were contaminated and the remaining 127 were subjected to in-vitro drug susceptibility testing against streptomycin, isoniazid, rifampicin and ethambutol. Twenty-six (20.47%) isolates were resistant to one or more drugs, seven (5.5%) were resistant to rifampicin singly or in combination, and 11 (8.7%) were resistant to isoniazid singly or in combination. Mono-resistance to isoniazid, rifampicin, streptomycin and ethambutol was detected in four (3.1%), one (0.8%), four (3.1%) and two (1.6%), respectively. Five children (3.9%) had MDR-TB; 101 (79.9%) children had Mtb isolates which were sensitive to all four drugs.

CONCLUSIONS

The rifampicin and isoniazid resistance rates were much higher than those in the adult TB population in India.

摘要

背景

结核分枝杆菌（Mtb）分离株的药物敏感性测试（DST）对于结核病的有效治疗至关重要。关于儿童结核病中Mtb分离株的DST模式的数据很少。

目的

确定印度北部一个儿科结核病队列中Mtb分离株的耐药模式。

方法

前瞻性纳入403名年龄在6个月至14岁之间、可能患有胸内结核病的儿童。所有儿童均未接受过治疗。将802份门诊诱导痰（IS）样本和787份胃抽吸物（GA）样本在BACTEC-MGIT960系统中培养，并使用自动化BACTEC-MGIT960 SIRE试剂盒对Mtb分离株进行DST。

结果

在403名儿童中，147名（36.4%）培养确诊：132株（89.8%）分离株为Mtb，15株（10.2%）为非结核分枝杆菌（NTM）。5株Mtb分离株被污染，其余127株接受了针对链霉素、异烟肼、利福平和乙胺丁醇的体外药物敏感性测试。26株（20.47%）分离株对一种或多种药物耐药，7株（5.5%）单独或联合对利福平耐药，11株（8.7%）单独或联合对异烟肼耐药。分别检测到4株（3.1%）、1株（0.8%）、4株（3.1%）和2株（1.6%）对异烟肼、利福平、链霉素和乙胺丁醇的单药耐药。5名儿童（3.9%）患有耐多药结核病；101名（79.9%）儿童的Mtb分离株对所有四种药物敏感。