Van Nguyen Hung, Binh Nguyen Hoa, Thu Ha Doan, Thi Huong Dinh, Ngoc Trung Vu, Thi Thuy Ngoc Khieu, Huyen Trang Tran, Vu Thi Ngoc Ha, Trinh Thi Bich Tram, Le Pham Tien Trieu, Nguyen Hong Hanh, Phan Trieu Phu, Kim Lan Luong, Lan Kim, Ngoc Hue Ngo, Thi Le Huong Nguyen, Le Thi Ngoc Thao Tran, Le Quang Nguyen, Do Dang Anh Thu, Hữu Lân Nguyễn, Van Vinh Truong, Thi Minh Ha Dang, Thuong Dat Phan, Phuc Hai Nguyen, Crook Derrick W, Thuy Thuong Thuong Nguyen, Viet Nguyen Nhung, Thwaites Guy E, Walker Timothy M
National Lung Hospital, Hanoi, Viet Nam.
Vietnam National University, University of Medicine and Pharmacy, Viet Nam.
J Clin Tuberc Other Mycobact Dis. 2024 Mar 15;35:100431. doi: 10.1016/j.jctube.2024.100431. eCollection 2024 May.
We conducted a descriptive analysis of multi-drug resistant tuberculosis (MDR-TB) in Vietnam's two largest cities, Hanoi and Ho Chi Minh city.
All patients with rifampicin resistant tuberculosis were recruited from Hanoi and surrounding provinces between 2020 and 2022. Additional patients were recruited from Ho Chi Minh city over the same time period. Demographic data were recorded from all patients, and samples collected, cultured, whole genome sequenced and analysed for drug resistance mutations. Genomic susceptibility predictions were made on the basis of the World Health Organization's catalogue of mutations in associated with drug resistance, version 2. Comparisons were made against phenotypic drug susceptibility test results where these were available. Multivariable logistic regression was used to assess risk factors for previous episodes of tuberculosis.
265 sequenced isolates were of sufficient quality for analysis, 146 (63 %) from Ho Chi Minh City and 87 (37 %) from Hanoi. 198 (85 %) were lineage 2, 20 (9 %) were lineage 4, and 15 (6 %) were lineage 1. 17/211 (8 %) for whom HIV status was known were infected, and 109/214 (51 %) patients had had a previous episode of tuberculosis. The main risk factor for a previous episode was HIV infection (odds ratio 5.1 (95 % confidence interval 1.3-20.0); p = 0.021). Sensitivity for predicting first-line drug resistance from whole genome sequencing data was over 90 %, with the exception of pyrazinamide (85 %). For moxifloxacin and amikacin it was 50 % or less. Among rifampicin-resistant isolates, prevalence of resistance to each non-first-line drug was < 20 %.
Drug resistance among most MDR-TB strains in Vietnam's two largest cities is confined largely to first-line drugs. Living with HIV is the main risk factor among patients with MDR-TB for having had a previous episode of tuberculosis.
我们对越南最大的两个城市河内和胡志明市的耐多药结核病（MDR-TB）进行了描述性分析。
2020年至2022年期间，从河内及其周边省份招募了所有对利福平耐药的结核病患者。同期从胡志明市招募了更多患者。记录了所有患者的人口统计学数据，并采集样本进行培养、全基因组测序以及耐药突变分析。根据世界卫生组织第2版与耐药相关的突变目录进行基因组药敏预测。在有可用结果的情况下，与表型药敏试验结果进行比较。采用多变量逻辑回归评估既往结核病发作的危险因素。
265株测序分离株质量足以进行分析，其中146株（63%）来自胡志明市，87株（37%）来自河内。198株（85%）为2型谱系，20株（9%）为4型谱系，15株（6%）为1型谱系。已知HIV感染状况的患者中，17/211（8%）感染HIV，109/214（51%）患者既往有过结核病发作。既往发作的主要危险因素是HIV感染（比值比5.1（95%置信区间1.3 - 20.0）；p = 0.021）。从全基因组测序数据预测一线耐药的敏感性超过90%，吡嗪酰胺除外（85%）。对于莫西沙星和阿米卡星，敏感性为50%或更低。在耐利福平分离株中，对每种非一线药物的耐药率均<20%。
越南两个最大城市的大多数耐多药结核菌株的耐药主要局限于一线药物。感染HIV是耐多药结核病患者既往有过结核病发作的主要危险因素。
