Sisco Maria Carolina, Gomes da Silva Marlei, Distasio de Carvalho Luciana, Dias Campos Carlos Eduardo, De Souza Caldas Paulo Cesar, Lopez Beatriz, Argüelles Claudia, Carvalho Ana Carolina, de Waard Jacobus, Suffys Philip, Silva Duarte Rafael
Laboratório de Micobactérias, Departamento de Microbiologia Médica, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Laboratório de Biologia Molecular Aplicada às Micobactérias, Instituto Oswaldo Cruz, Rio de Janeiro, Brazil.
Infect Drug Resist. 2021 Feb 5;14:459-466. doi: 10.2147/IDR.S248096. eCollection 2021.
Bacillus Calmette-Guérin (BCG) is the only vaccine licensed against tuberculosis. Despite the protection offered by the vaccine, in some circumstances children and immunocompromised individuals can develop associated infections, known as BCGitis. Drug susceptibility patterns of BCG clinical strains have rarely been described. We aimed to describe the susceptibility pattern of BCG clinical strains isolated in two different countries.
We performed culture-based drug susceptibility testing of thirty one BCG strains isolated from patients in Brazil (n=5, 16%) and Argentina (n=26, 84%) using the broth micro-dilution method (phenotypic method). Final antibiotic concentrations for susceptibility testing ranged from 0.5 to 16 mg/L for amikacin, 0.3125 to 10 mg/L for ethambutol, 0.05 to 1.6 mg/L for isoniazid and 0.25 to 8 mg/L for rifampicin, streptomycin and ofloxacin. Additionally, we compared the results with genetic data obtained by whole genome sequencing.
By using the phenotypic method we detected one strain resistant to ethambutol, three strains resistant to rifampicin and one resistant to isoniazid. Additionally, two strains that were phenotypically resistant to both isoniazid and rifampicin carried mutations in the and genes simultaneously.
There is evidence of the emergence of BCG-resistant strains isolated from vaccine-related complications. We recommend drug susceptibility testing of the BCG strain causing the infection in order to prevent treatment failure.
卡介苗（BCG）是唯一被批准用于预防结核病的疫苗。尽管该疫苗能提供保护，但在某些情况下，儿童和免疫功能低下的个体可能会发生相关感染，即卡介苗病。卡介苗临床菌株的药敏模式鲜有描述。我们旨在描述在两个不同国家分离出的卡介苗临床菌株的药敏模式。
我们采用肉汤微量稀释法（表型方法），对从巴西（n = 5，16%）和阿根廷（n = 26，84%）患者中分离出的31株卡介苗菌株进行了基于培养的药敏试验。药敏试验的最终抗生素浓度范围为：阿米卡星0.5至16mg/L，乙胺丁醇0.3125至10mg/L，异烟肼0.05至1.6mg/L，利福平、链霉素和氧氟沙星0.25至8mg/L。此外，我们将结果与通过全基因组测序获得的遗传数据进行了比较。
通过表型方法，我们检测到1株对乙胺丁醇耐药的菌株，3株对利福平耐药的菌株和1株对异烟肼耐药的菌株。此外，2株对异烟肼和利福平均表现出表型耐药的菌株，其 和 基因同时发生了突变。
有证据表明从疫苗相关并发症中分离出了卡介苗耐药菌株。我们建议对引起感染的卡介苗菌株进行药敏试验，以防止治疗失败。
