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目的分析常熟地区耐药肺结核高危人群的耐药监测结果,为该地区耐药肺结核病的防治提供参考。方法收集2012-2016年常熟地区4类耐药肺结核高危人群(治疗2、3个月末痰涂片阳性、初治失败、复发、复治失败)痰涂片阳性标本,进行菌型鉴定和对异烟肼(H)、利福平(R)、链霉素(S)、乙胺丁醇(E)进行药敏试验,分析其耐药谱。结果2012-2016年常熟地区共发现318例耐药肺结核高危人群,其中244例鉴定为结核分枝杆菌感染,且获得药敏试验结果。244株结核分枝杆菌中共有78株被判断为耐药株(总耐药率为32.0%),其中单耐药率15.6%、多耐药率2.9%、耐多药率13.5%。耐药患者以男性、农民、50岁以上者为主。对4种抗结核药中任意1种的耐药率由高到低的排序是H>R>S>E;共发现10种耐药谱,其中单耐药以耐S为主(19.2%),多耐药以耐H+S为主(7.7%),耐多药以H+R+S为主(15.4%)。结论常熟地区耐药肺结核高危人群的总耐药率为32.0%,其中以老年男性农民患者为主,耐药谱以耐S、耐H+S和耐H+R+S为主。
Objective To analyze the drug resistance surveillance results of drug-resistant TB patients in Changshu area and provide reference for the prevention and treatment of drug-resistant TB disease in this area. Methods The positive sputum smear specimens from four groups of high-risk drug-resistant pulmonary tuberculosis patients in Changshu district (positive sputum smear at the end of 2, 3 months, failed initial treatment, relapse and retreatment) in 2012-2016 were collected and identified. (H), rifampicin (R), streptomycin (S), ethambutol (E) for susceptibility testing, analysis of drug resistance spectrum. Results A total of 318 high-risk drug-resistant pulmonary tuberculosis patients were found in Changshu area during 2012-2016, of which 244 were identified as Mycobacterium tuberculosis infection and drug-susceptibility test results were obtained. Of 244 strains of Mycobacterium tuberculosis, 78 strains were identified as resistant strains (total resistance rate was 32.0%), of which single drug resistance rate was 15.6%, multi-drug resistance rate 2.9% and multi-drug resistance rate 13.5%. Drug-resistant patients to men, farmers, more than 50-based. Among the four anti-tuberculosis drugs, the order of high to low resistance was H> R> S> E. Ten drug resistance spectrum were found, among which single drug resistance was resistant to S (19.2%), , Resistant to H + S (7.7%), resistant to H + R + S (15.4%). Conclusions The total drug resistance rate of high-risk drug-resistant pulmonary tuberculosis patients in Changshu was 32.0%, of which elderly male farmers were the mainstay. The resistant spectrum was resistant to S, H + and H + R + S resistant.