台湾南部地区一线和二线抗结核药物耐药情况：对经验性治疗的影响。

Resistance to first- and second-line antituberculosis drugs in Southern Taiwan: Implications for empirical treatment.

机构信息

Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Internal Medicine, Ministry of Health and Welfare Pingtung Hospital, Pingtung, Taiwan.

Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.

出版信息

J Microbiol Immunol Infect. 2018 Feb;51(1):88-93. doi: 10.1016/j.jmii.2017.05.008. Epub 2017 Jun 29.

DOI:10.1016/j.jmii.2017.05.008

PMID:28698044

Abstract

BACKGROUND

Multidrug-resistant and extensively drug-resistant tuberculosis infections cause public health concerns worldwide. Local epidemiologic data about the drug resistance of Mycobacterium tuberculosis isolate (Mtb) is critical to guide appropriate empirical therapy to cure patients and restrain the spread of tuberculosis.

METHODS

Antituberculosis susceptibility testing was performed for 287 Mtbs, including 63 MDR-Mtbs collected in southern Taiwan from 2011 to 2015. Tuberculosis patients were classified into newly diagnosed cases and previously treated cases based on patients' medical history.

RESULTS

Almost no resistance was found to the tested second-line antituberculosis drugs in non-MDR-Mtbs. Higher resistance rates to ethambutol, ofloxacin, and streptomycin were observed in MDR-Mtbs compared to non-MDR-Mtbs. Among 63 MDR-Mtbs, 61.9% of patients were newly diagnosed and 38.1% were previously treated cases. For MDR-Mtb, the drug-resistance rates in previously treated cases were significantly higher for ethambutol, pyrazinamide, ofloxacin, moxifloxacin, streptomycin, and p-aminosalicylic acid. When MDR-Mtbs are identified in previously treated cases, empirical administration of ethambutol, pyrazinamide, ofloxacin, or moxifloxacin may not provide effective treatment. The resistance rates to these drugs were all more than 50%. Furthermore, 25% of MDR-Mtbs from previously treated patients were resistant to p-aminosalicylic acid.

CONCLUSION

We observed almost no resistance to the tested second-line antituberculosis drugs among non-MDR-Mtbs. Anti-tuberculosis regimen with pyrazinamide, ethambutol, fluoroquinolone, kanamycin, cycloserine and p-aminosalicylic acid can be empirically used for newly diagnosed MDR-TB cases. For previously treated MDR-TB patients, empirical ethambutol, pyrazinamide, ofloxacin, or moxifloxacin may not provide effective treatment because the resistance rates to these drugs were all >50%.

摘要

背景

耐多药和广泛耐药结核感染引起了全球公共卫生关注。了解分枝杆菌分离株（Mtb）的药物耐药性的当地流行病学数据对于指导适当的经验性治疗以治愈患者和遏制结核病的传播至关重要。

方法

对 287 株结核分枝杆菌进行了抗结核药物敏感性测试，包括 2011 年至 2015 年在台湾南部收集的 63 株 MDR-Mtb。根据患者病史，将结核病患者分为新发和既往治疗病例。

结果

非耐多药 Mtb 对所测试的二线抗结核药物几乎没有耐药性。与非耐多药 Mtb 相比，MDR-Mtb 对乙胺丁醇、氧氟沙星和链霉素的耐药率更高。在 63 株 MDR-Mtb 中，61.9%的患者为新发，38.1%为既往治疗病例。对于 MDR-Mtb，在既往治疗病例中，乙胺丁醇、吡嗪酰胺、氧氟沙星、莫西沙星、链霉素和对氨基水杨酸的耐药率明显更高。当在既往治疗病例中发现 MDR-Mtb 时，经验性给予乙胺丁醇、吡嗪酰胺、氧氟沙星或莫西沙星可能无法提供有效治疗。这些药物的耐药率均超过 50%。此外，25%的来自既往治疗患者的 MDR-Mtb 对对氨基水杨酸耐药。

结论

我们观察到非耐多药 Mtb 对所测试的二线抗结核药物几乎没有耐药性。对于新发 MDR-TB 病例，可以经验性使用含吡嗪酰胺、乙胺丁醇、氟喹诺酮类、卡那霉素、环丝氨酸和对氨基水杨酸的抗结核方案。对于既往治疗的 MDR-TB 患者，经验性使用乙胺丁醇、吡嗪酰胺、氧氟沙星或莫西沙星可能无法提供有效治疗，因为这些药物的耐药率均超过 50%。