Hu Y, Xu L, He Y L, Pang Y, Lu N, Liu J, Shen J, Zhu D M, Feng X, Wang Y W, Yang C
Tuberculosis Reference Laboratory, Chongqing Tuberculosis Control Institute, Chongqing 400050, China.
Department of Pathogenic Organisms, Chongqing Medical University, Chongqing 400016, China.
Biomed Res Int. 2017;2017:4563826. doi: 10.1155/2017/4563826. Epub 2017 Jul 17.
This study aimed to investigate the prevalence of multidrug-resistant tuberculosis (MDR-TB) isolates resistant to the second-line antituberculosis drugs (SLDs) and its association with resistant-related gene mutations in () isolates from Southwest of China. There were 81 isolates resistant to at least one of the SLDs among 156 MDR-TB isolates (81/156, 51.9%). The rates of general resistance to each of the drugs were as follows: OFX (66/156, 42.3%), KAN (26/156, 16.7%), CAP (13/156, 8.3%), PTO (11/156, 7.1%), PAS (22/156, 14.1%), and AMK (20/156, 12.8%). Therefore, the most predominant pattern was resistant to OFX compared with other SLDs ( < 0.001). The results of sequencing showed that 80.2% OFX-resistant MDR-TB isolates contained mutation and 88.5% KAN-resistant isolates had mutations with the most frequent mutation being A1401G. These results suggest that improper use of SLDs especially OFX is a real threat to effective MDR-TB treatment not only in China but also in the whole world. Furthermore the tuberculosis control agencies should carry out SLDs susceptibility testing and rapid screening in a broader population of TB patients immediately and the SLDs should be strictly regulated by the administration in order to maintain their efficacy to treat MDR-TB.
本研究旨在调查中国西南部（）株耐多药结核病（MDR-TB）分离株对二线抗结核药物（SLDs）的耐药情况及其与耐药相关基因突变的关联。在156株MDR-TB分离株中，有81株对至少一种SLD耐药（81/156，51.9%）。各药物的总体耐药率如下：氧氟沙星（OFX，66/156，42.3%）、卡那霉素（KAN，26/156，16.7%）、卷曲霉素（CAP，13/156，8.3%）、丙硫异烟胺（PTO，11/156，7.1%）、对氨基水杨酸（PAS，22/156，14.1%）和阿米卡星（AMK，20/156，12.8%）。因此，与其他SLD相比，最主要的耐药模式是对OFX耐药（<0.001）。测序结果显示，80.2%的耐OFX MDR-TB分离株存在突变，88.5%的耐KAN分离株存在突变，最常见的突变是A1401G。这些结果表明，不当使用SLD尤其是OFX不仅在中国，而且在全世界对MDR-TB的有效治疗都是一个真正的威胁。此外，结核病控制机构应立即对更广泛的结核病患者群体进行SLD药敏试验和快速筛查，并且行政部门应严格监管SLD，以维持其治疗MDR-TB的疗效。
