National Reference laboratory, Department of Microbiology, Bhopal Memorial Hospital, and Research Centre, Bhopal M.P. 462038, India.
World Health Organization, New Delhi, India.
Trans R Soc Trop Med Hyg. 2020 Apr 8;114(4):249-254. doi: 10.1093/trstmh/trz121.
Drug-resistant TB is a serious public health problem in India. Pre-existing resistance to fluoroquinolones (FQs) and second-line injectable drugs (SLIDs) in strains of Mycobacterium tuberculosis (MTB) resistant to rifampicin (RIF) and/or isoniazid (INH) contributes to treatment failures and consequent transmission of drug-resistant TB. A baseline assessment of resistance of MTB to FQs and SLIDs may help guide policies to further improve management of drug-resistant TB in India. This study aims to determine the prevalence of resistance to FQs and SLIDs among MTB strains having RIF and/or INH resistance in central India.
A total of 1032 smear positive sputum samples were subjected to line probe assay (GenoType MTBDRsl version 2) to test for resistance to FQs and SLIDs, according to the integrated diagnostic algorithm of the revised national TB control programme.
Of 1032 samples, 92 (8.91%) were not interpretable and hence excluded, 295 (31.38%) were resistant to FQs alone, 13 (1.38%) were resistant to SLIDs alone, 15 (1.59%) were resistant to both FQs as well as SLIDs and 617 (65.63%) were sensitive to both FQs and SLIDs. The most common mutations in gyrA and gyrB genes were observed at codons D94G and E540V, respectively. Mutations at codon A1401G in rrs genes and in the C-14 T region of eis genes were most frequently observed.
High levels of FQ resistance points towards indiscriminate use of this class of drugs. Regulation for judicial use of FQs is an urgent requirement.
耐药结核病是印度严重的公共卫生问题。在耐利福平（RIF）和/或异烟肼（INH）的结核分枝杆菌（MTB）菌株中，氟喹诺酮类药物（FQs）和二线注射药物（SLIDs）预先存在的耐药性导致治疗失败，并导致耐药结核病的传播。对 MTB 对 FQs 和 SLIDs 的耐药性进行基线评估可能有助于指导政策，进一步改善印度耐药结核病的管理。本研究旨在确定印度中部 RIF 和/或 INH 耐药 MTB 菌株对 FQs 和 SLIDs 的耐药率。
对 1032 份涂片阳性痰液样本进行线性探针检测（GenoType MTBDRsl version 2），根据修订后的国家结核病控制规划综合诊断算法，检测对 FQs 和 SLIDs 的耐药性。
在 1032 个样本中，92 个（8.91%）不可解释，因此被排除在外，295 个（31.38%）单独对 FQs 耐药，13 个（1.38%）单独对 SLIDs 耐药，15 个（1.59%）对 FQs 和 SLIDs 均耐药，617 个（65.63%）对 FQs 和 SLIDs 均敏感。gyrA 和 gyrB 基因中最常见的突变分别发生在密码子 D94G 和 E540V。rrs 基因中 A1401G 密码子和 eis 基因中的 C-14T 区的突变最为常见。
高水平的 FQ 耐药表明此类药物的滥用。迫切需要对 FQs 的司法使用进行监管。
