加纳耐多药结核病患者耐药性分析发现多例广泛耐药前结核病病例。
Analysis of drug resistance among difficult-to-treat tuberculosis patients in Ghana identifies several pre-XDR TB cases.
作者信息
Otchere Isaac Darko, Morgan Portia Abena, Asare Prince, Osei-Wusu Stephen, Aboagye Samuel Yaw, Yirenkyi Stephen Ofori, Musah Abdul Basit, Danso Emelia Konadu, Tetteh-Ocloo Georgina, Afum Theophilus, Asante-Poku Adwoa, Laryea Clement, Poku Yaw Adusi, Bonsu Frank, Gagneux Sebastien, Yeboah-Manu Dorothy
机构信息
Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana.
Institute for Environment and Sanitation Studies, College of Basic and Applied Sciences, University of Ghana, Accra, Ghana.
出版信息
Front Microbiol. 2023 Jan 12;13:1069292. doi: 10.3389/fmicb.2022.1069292. eCollection 2022.
BACKGROUND
Resistance to tuberculosis (TB) drugs has become a major threat to global control efforts. Early case detection and drug susceptibility profiling of the infecting bacteria are essential for appropriate case management. The objective of this study was to determine the drug susceptibility profiles of difficult-to-treat (DTT) TB patients in Ghana.
METHODS
Sputum samples obtained from DTT-TB cases from health facilities across Ghana were processed for rapid diagnosis and detection of drug resistance using the Genotype MTBDR and Genotype MTBDR. from Hain Life science.
RESULTS
A total of 298 (90%) out of 331 sputum samples processed gave interpretable bands out of which 175 (58.7%) were resistant to at least one drug (ANY); 16.8% (50/298) were isoniazid-mono-resistant (INH), 16.8% (50/298) were rifampicin-mono-resistant (RIF), and 25.2% (75/298) were MDR. 24 (13.7%) of the ANY were additionally resistant to at least one second line drug: 7.4% (2 RIF, 1 INH, and 10 MDR samples) resistant to only FQs and 2.3% (2 RIF, 1 INH, and 1 MDR samples) resistant to AMG drugs kanamycin (KAN), amikacin (AMK), capreomycin (CAP), and viomycin (VIO). Additionally, there were 4.0% (5 RIF and 2 MDR samples) resistant to both FQs and AMGs. 81 (65.6%) out of 125 INH-resistant samples including INH and MDR had -mutations (MT) whereas 15 (12%) had -MT. The remaining 28 (22.4%) had both and MT. All the 19 FQ-resistant samples were mutants whereas the 10 AMGs were (3), (3) as well as , and co-mutants (4). Except for the seven pre-XDR samples, no sample had MT.
CONCLUSION
The detection of several pre-XDR TB cases in Ghana calls for intensified drug resistance surveillance and monitoring of TB patients to, respectively, ensure early diagnosis and treatment compliance.
背景
结核病药物耐药性已成为全球结核病防控工作的重大威胁。早期病例发现以及对感染细菌进行药物敏感性分析对于恰当的病例管理至关重要。本研究的目的是确定加纳难治性结核病患者的药物敏感性情况。
方法
从加纳各地医疗机构的难治性结核病例中获取痰标本，使用海因生命科学公司的Genotype MTBDRplus和Genotype MTBDRsl进行快速诊断和耐药性检测。
结果
在处理的331份痰标本中，共有298份（90%）产生了可解读的条带，其中175份（58.7%）对至少一种药物耐药（ANY）；16.8%（50/298）为异烟肼单耐药（INH），16.8%（50/298）为利福平单耐药（RIF），25.2%（75/298）为耐多药。在ANY耐药的样本中，24份（13.7%）还对至少一种二线药物耐药：7.4%（2份RIF、1份INH和10份耐多药样本）仅对氟喹诺酮类耐药，2.3%（2份RIF、1份INH和1份耐多药样本）对氨基糖苷类药物卡那霉素（KAN）、阿米卡星（AMK）、卷曲霉素（CAP）和紫霉素（VIO）耐药。此外，有4.0%（5份RIF和2份耐多药样本）对氟喹诺酮类和氨基糖苷类均耐药。在125份包括异烟肼耐药和耐多药的异烟肼耐药样本中，81份（65.6%）有katG突变（MT），而15份（12%）有inhA - MT。其余28份（22.4%）既有katG又有inhA MT。所有19份对氟喹诺酮类耐药的样本均为gyrA突变体，而10份对氨基糖苷类耐药的样本为rrs（3份）、eis（3份）以及rrs和eis共突变（4份）。除7份准广泛耐药样本外，没有样本有rpoB MT。
结论
在加纳检测到多例准广泛耐药结核病例，这就需要加强耐药性监测并对结核病患者进行监测，以分别确保早期诊断和治疗依从性。
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