Sifuentes-Osornio J, Ponce-de-León L A, Camacho-Mezquita F E, Bobadilla-del-Valle J M, Infante-Suárez M L, Ramírez-Fernández N, Hernández-Gómez L, Nelson A M
Departamento de Infectología, Instituto Nacional de la Nutrición Salvador Zubirán.
Rev Invest Clin. 1995 Jul-Aug;47(4):273-81.
To determine the clinical manifestations associated with resistant M. tuberculosis infection and the antimicrobial resistance in isolates from Mexican patients.
Epidemiological surveillance.
Tuberculosis confirmed cases.
Primary resistance: no history of treatment prior to diagnosis. The following critical concentrations (micrograms/mL) were used for susceptibility: isoniazid 0.2 and 1; rifampin 1 and 5; ethambutol 5 and 10; streptomycin 2 and 10; ethionamide 5; kanamycin 6; and para-aminosalicylic acid (PAS) 2 and 10.
Eighty-four patients with a mean age of 44.7 years were included; 54 men (64%) and 30 women (36%); most patients were from the Mexico City metropolitan area. In 34 patients there was clinical information available, 26 presented fever and weight loss and 8 respiratory symptoms. Fifty-nine patients (70%) were infected by pan-susceptible M. tuberculosis, and 25 (30%) by a resistant isolate; 17 (68%) of them were resistant to at least two drugs, 16 (64%) to isoniazid and rifampin. The proportion of resistance was: isoniazid 24%, rifampin 19%, streptomycin 12%, ethambutol 10%, PAS 9%, etionamide 7%, and kanamycin 6%. Of 47 patients without previous treatment, eight had a resistant microorganism (17%): 9% resistant to isoniazid, 6% to rifampin, 2% to streptomycin, 6% to PAS and 6% multiresistant. Of 37 patients with history of previous treatment for tuberculosis, 17 (46%) had a resistant isolate; 44% were resistant to isoniazid, 35% to rifampin, 24% to streptomycin, 19% to ethambutol, 12% to PAS and 35% multiresistant. Of the 84 patients, four were physicians infected by a resistant isolate, and seven HIV-infected patients, one with a multiresistant isolate, and another with isoniazid resistance.
Antimicrobial resistance among M. tuberculosis is alarmingly high in Mexico City; these results emphasize the importance of case detection and early isolation of patients.
确定与耐多药结核分枝杆菌感染相关的临床表现以及墨西哥患者分离株中的抗菌药物耐药情况。
流行病学监测。
结核病确诊病例。
原发耐药：诊断前无治疗史。药敏试验采用以下临界浓度（微克/毫升）：异烟肼0.2和1；利福平1和5；乙胺丁醇5和10；链霉素2和10；乙硫异烟胺5；卡那霉素6；对氨基水杨酸（PAS）2和10。
纳入84例患者，平均年龄44.7岁；男性54例（64%），女性30例（36%）；大多数患者来自墨西哥城大都市区。34例患者有临床资料，26例有发热和体重减轻症状，8例有呼吸道症状。59例患者（70%）感染的是全敏感结核分枝杆菌，25例（30%）感染的是耐药菌株；其中17例（68%）对至少两种药物耐药，16例（64%）对异烟肼和利福平耐药。耐药比例分别为：异烟肼24%，利福平19%，链霉素12%，乙胺丁醇10%，PAS 9%，乙硫异烟胺7%，卡那霉素6%。在47例未接受过治疗的患者中，8例有耐药微生物（17%）：对异烟肼耐药9%，对利福平耐药6%，对链霉素耐药2%，对PAS耐药6%，多重耐药6%。在37例有结核病既往治疗史的患者中，17例（46%）有耐药菌株；对异烟肼耐药44%，对利福平耐药35%，对链霉素耐药24%，对乙胺丁醇耐药19%，对PAS耐药12%，多重耐药35%。在84例患者中，4例是被耐药菌株感染的医生，7例是HIV感染患者，1例是多重耐药菌株感染，另1例是异烟肼耐药。
墨西哥城结核分枝杆菌的抗菌药物耐药率高得惊人；这些结果强调了病例发现和患者早期隔离的重要性。
