印度北部一家三级护理中心的肺部外结核患者中氟喹诺酮类药物耐药率较高。

High degree of fluoroquinolone resistance among extrapulmonary tuberculosis patients at a tertiary care center in North India.

机构信息

Department of Medicine, All India Institute of Medical Sciences, New Delhi; School of Life Sciences, Jaipur National University, Jaipur, Rajasthan, India.

School of Life Sciences, Jaipur National University, Jaipur, Rajasthan, India.

出版信息

Int J Mycobacteriol. 2020 Jul-Sep;9(3):309-312. doi: 10.4103/ijmy.ijmy_116_20.

DOI:10.4103/ijmy.ijmy_116_20

PMID:32862166

Abstract

BACKGROUND

The treatment of drug-resistant tuberculosis (TB) involves various regimens. Among them, the most promising antibiotic regimens are fluoroquinolone (FQ) drugs. Drug susceptibility testing (DST) for FQs is not included as routine assessment for baseline TB diagnosis. Limited resources are available about FQ resistance among extrapulmonary TB (EPTB) cases.

METHODS

A total of 447 culture-positive specimens were subjected to DST for first-line anti-TB drugs (FLDs) and second-line anti-TB drugs. DST was performed using automated mycobacterium growth indicator tube-960 liquid culture techniques. The study was carried out during the period of April 2016 to March 2017. In addition, DST of FQs was also performed in FLD-sensitive strains.

RESULTS

Mycobacterium tuberculosis was isolated from 447 specimens. Of the 447 culture-positive EPTB specimens, 54 were rifampicin-resistant (RR)/multidrug-resistant TB (MDR-TB) isolates, 45 isolates were resistant to any drug, and the remaining 348 were sensitive to FLDs. Monoresistance of FQs was observed in 20.4% (11/54) among RR/MDR-TB isolates and 4.3% (15/348) among FLD-sensitive isolates.

CONCLUSION

The high degree of FQ resistance observed in EPTB specimens among drug-sensitive and MDR-TB isolates is alarming. This study reflects the need to expand culture and DST for EPTB cases and include FQs within first-line DST in such settings. Furthermore, there should be a rational use of FQs for the treatment of other diseases.

摘要

背景

耐多药结核病（TB）的治疗涉及多种方案。其中，最有前途的抗生素方案是氟喹诺酮（FQ）类药物。FQ 类药物的药物敏感性测试（DST）不包括在基线结核病诊断的常规评估中。关于肺外结核病（EPTB）病例中 FQ 耐药的资源有限。

方法

共对 447 份培养阳性标本进行了一线抗结核药物（FLDs）和二线抗结核药物的 DST。DST 使用自动化分枝杆菌生长指示剂管-960 液体培养技术进行。该研究于 2016 年 4 月至 2017 年 3 月期间进行。此外，还对 FLD 敏感株进行了 FQ 的 DST。

结果

从 447 份标本中分离出结核分枝杆菌。在 447 份培养阳性的 EPTB 标本中，54 份为利福平耐药（RR）/耐多药结核病（MDR-TB）分离株，45 份对任何药物均耐药，其余 348 份对 FLDs 敏感。RR/MDR-TB 分离株中，FQ 单耐药率为 20.4%（11/54），FLD 敏感分离株中为 4.3%（15/348）。