和在埃塞俄比亚东部索马里地区的临床分离株的药敏与其细菌基因型的相关性。
Drug sensitivity of clinical isolates of and its association with bacterial genotype in the Somali region, Eastern Ethiopia.
机构信息
College of Medicine and Health Sciences, Jigjiga University, Jigjiga, Ethiopia.
Animal Health and Zoonotic Unit, Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia.
出版信息
Front Public Health. 2022 Aug 17;10:942618. doi: 10.3389/fpubh.2022.942618. eCollection 2022.
BACKGROUND
Drug resistance is becoming a major bottleneck for tuberculosis (TB) control programs in countries with high TB burdens. Although several studies were conducted on the drug sensitivity of () in central Ethiopia, there is a lack of data on the drug sensitivity of in the peripheral regions of the country including in the Somali region. Therefore, the objective of this study was to evaluate the drug sensitivity of and its association with bacterial genotype and evaluate the performance of Xpert MTB/RIF (Xpert) in detecting resistance to rifampicin (RIF).
METHODS
A total of 302 were tested using the BD BACTEC-Mycobacteria Growth Indicator Tube 960 (MGIT 960) system for their drug sensitivity to the first-line anti-TB drugs. Besides, the drug sensitivity of 10 multidrug-resistant (MDR) isolates was evaluated for the second-line anti-TB drugs. Additionally, 177 of the 302 isolates were tested for genotypic drug resistance using Xpert. Chi-square and Fisher's exact tests were used for the evaluation of the association between variables and drug sensitivity.
RESULTS
The overall prevalence of resistance to at least one drug was 11.6% (95% CI: 7.9-15.2%), while the prevalence of MDR was 3.3% (95% CI: 1.3-5.3%). Two of the 10 MDR isolates were resistant to capreomycin. The spoligotype Shared International Type (SIT) 149 was significantly associated with either monoresistance or MDR ( < 0.05). Of the 177 isolates tested by Xpert, 6.2% (11/177) were RIF-resistant. Discordant between Xpert and MGIT 960 was observed in one isolate and linked with probe-binding delay (ΔCT max = 5.8). The sensitivity and specificity of the Xpert assay were 100 and 99.4%, respectively, while its positive and negative predictive values were 90.9 and 100%, respectively.
CONCLUSION
The magnitude of MDR in the Somali region of Ethiopia was higher than the national prevalence of MDR-TB warranting the strengthening of the TB control program in the Somali region. Besides, drug resistance was associated with SIT 149 spoligotype (genotype). The Xpert assay was observed to have high sensitivity and specificity in detecting RIF-resistant , which is encouraging for its application widely.
背景
耐药性正在成为高负担国家结核病（TB）控制计划的主要瓶颈。尽管在埃塞俄比亚中部进行了几项关于（）药物敏感性的研究，但该国包括索马里地区在内的周边地区的（）药物敏感性数据仍然缺乏。因此，本研究的目的是评估（）的药物敏感性及其与细菌基因型的关联，并评估 Xpert MTB/RIF（Xpert）检测利福平（RIF）耐药性的性能。
方法
使用 BD BACTEC-Mycobacteria Growth Indicator Tube 960（MGIT 960）系统对 302 株进行了一线抗结核药物敏感性测试。此外，还评估了 10 株耐多药（MDR）分离株对二线抗结核药物的药物敏感性。此外，对 302 株分离株中的 177 株进行了 Xpert 基因耐药性测试。卡方检验和 Fisher 确切检验用于评估变量与药物敏感性之间的关联。
结果
至少一种药物耐药的总流行率为 11.6%（95%CI：7.9-15.2%），而 MDR 的流行率为 3.3%（95%CI：1.3-5.3%）。10 株 MDR 分离株中有 2 株对卷曲霉素耐药。共享国际型（SIT）149 spoligotype 与单耐药或 MDR 显著相关（<0.05）。用 Xpert 测试的 177 株分离株中，有 6.2%（11/177）为利福平耐药。在一个分离株中观察到 Xpert 和 MGIT 960 之间存在不一致，与探针结合延迟（ΔCT max = 5.8）有关。Xpert 检测的灵敏度和特异性分别为 100%和 99.4%，阳性预测值和阴性预测值分别为 90.9%和 100%。
结论
埃塞俄比亚索马里地区 MDR 的严重程度高于全国耐多药结核病的流行率，这需要加强索马里地区的结核病控制计划。此外，耐药性与 SIT 149 spoligotype（基因型）相关。Xpert 检测法在检测利福平耐药方面具有较高的灵敏度和特异性，这令人鼓舞，有望广泛应用。
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