Li Xueqiu, Liu Jianxiong
Department of One Branch, Guangzhou Chest Hospital, State Key Laboratory of Respiratory Disease, Guangzhou Key Laboratory of Tuberculosis, Guangzhou, China.
State Key Laboratory of Respiratory Disease, Guangzhou Key Laboratory of Tuberculosis, Guangzhou Chest Hospital, Institute of Tuberculosis, Guangzhou Medical University, Guangzhou, China.
Immun Inflamm Dis. 2024 Nov;12(11):e70060. doi: 10.1002/iid3.70060.
The objectives of the study are to understand the drug-resistant situation and trend of tuberculosis patients in Yuexiu District, Guangzhou City, from 2013 to 2022, and to provide a scientific basis for the development of rational drug-resistant tuberculosis prevention and control strategies in Guangzhou City.
All patients who were diagnosed with active tuberculosis in Guangzhou Chest Hospital from January 1, 2013 to December 31, 2022 were collected as study subjects, and a total of 5191 patients were enrolled in the study. Comprehensive data on the basic characteristics, diagnostic, and therapeutic information of the study subjects were collected. Sputum specimens were subjected to smear, isolation, and culture. Culture-positive strains of bacteria were identified by bacterial groups. A total of 1659 strains of Mycobacterium tuberculosis (MTB) isolates were obtained. The drug susceptibility test was carried out using the proportionality method on the MTB isolates for nine types of antituberculosis medicines: isoniazid (INH), rifampicin (RFP), ethambutol (EMB), streptomycin (Sm), kanamycin (Km), ofloxacin (Ofx), capreomycin (Cm), propylthioisonicotinamide (Pto), and p-aminosalicylic acid (PAS). A comparative analysis of the resistance patterns among the strains was conducted.
A total of 1659 patients with MTB were cultured, revealing 438 drug-resistant cases. Among these, 255 were monoresistant, 121 were polyresistant, and 62 were multidrug resistant. The overall resistance rate was 26.40% (438/1659), with mono-resistance rate at 15.37% (255/1659), polyresistance rate at 7.29% (121/1659), and multidrug resistance rate at 3.74% (62/1659). In descending order, the resistance rates of MTB isolates to any of the nine antituberculosis drugs were Sm (12.24%, 203/1659), INH (9.22%, 153/1659), EMB (7.35%, 122/1659), RFP (6.99%, 116/1659), PAS (3.25%, 54/1659), Pto (3.13%, 52/1659), Ofx (2.71%, 45/1659), Cm (2.17%, 36/1659), and Km (2.17%, 36/1659). The differences in resistance rates were statistically significant (p < 0.01), with Sm exhibiting the highest resistance rate and Km the lowest. In the primary treatment group, 388 patients (25.55%) were drug resistant, while 50 patients (35.46%) in the retreatment group were drug resistant. Thirty-nine patients (2.57%) in the primary treatment group were multidrug resistant, compared to 23 patients (16.31%) in the retreatment group. The resistance rate and multidrug resistance rate of isolates from retreatment patients were significantly higher than primary treatment patients (p < 0.05).
The problem of drug-resistant tuberculosis transmission in Guangzhou requires attention, and drug-resistant screening should be further increased to effectively control the source of infection.
本研究的目的是了解2013年至2022年广州市越秀区结核病患者的耐药情况及趋势，为制定广州市合理的耐药结核病防控策略提供科学依据。
收集2013年1月1日至2022年12月31日在广州市胸科医院确诊为活动性结核病的所有患者作为研究对象，共纳入5191例患者。收集研究对象的基本特征、诊断及治疗信息等综合数据。对痰标本进行涂片、分离和培养。通过菌群鉴定培养阳性的菌株。共获得1659株结核分枝杆菌（MTB）分离株。采用比例法对MTB分离株进行九种抗结核药物的药敏试验，这九种药物分别为异烟肼（INH）、利福平（RFP）、乙胺丁醇（EMB）、链霉素（Sm）、卡那霉素（Km）、氧氟沙星（Ofx）、卷曲霉素（Cm）、丙硫异烟胺（Pto）和对氨基水杨酸（PAS）。对菌株间的耐药模式进行比较分析。
共培养出1659例MTB患者，其中耐药病例438例。其中，单耐药255例，多耐药121例，耐多药62例。总耐药率为26.40%（438/1659），单耐药率为15.37%（255/1659），多耐药率为7.29%（121/1659），耐多药率为3.74%（62/1659）。MTB分离株对九种抗结核药物中任何一种的耐药率由高到低依次为：Sm（12.24%，203/1659）、INH（9.22%，153/1659）、EMB（7.35%，122/1659）、RFP（6.99%，116/1659）、PAS（3.25%，54/1659）、Pto（3.13%，52/1659）、Ofx（2.71%，45/1659）、Cm（2.17%，36/1659）、Km（2.17%，36/1659）。耐药率差异有统计学意义（p＜0.01），Sm耐药率最高，Km最低。初治组388例患者（25.55%）耐药，而复治组50例患者（35.46%）耐药。初治组39例患者（2.57%）耐多药，而复治组23例患者（16.31%）耐多药。复治患者分离株的耐药率和耐多药率显著高于初治患者（p＜0.05）。
广州耐药结核病传播问题需引起关注，应进一步加强耐药筛查以有效控制传染源。
