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目的分析海南省结核病医院502株结核菌株的耐药类型及分布情况,为制定耐药结核病治疗方案提供科学依据。方法收集2014年1月至2016年12月期间收治的经痰分离培养并鉴定为结核分枝杆菌复合群的共502株菌株,进行8种抗结核药物(异烟腆、利福平、乙胺丁醇、链霉素、卡那霉素、卷曲霉素、氧氟沙星以及丙硫异烟胺)的药物敏感性试验,对其结果进行分析。结果总耐药率为43.6%(219/502),2015、2016年总耐药率明显高于2014年(=10.136,P=0.001;=8.56,P=0.003);总耐多药率为25.5%(128/502),近3年耐多药疫情无明显变化(=3.297,P>0.05);抗结核药物耐药率由高到低依次为利福平>异烟肼>链霉素>氧氟沙星>乙胺丁醇>卡那霉素>卷曲霉素>丙硫异烟胺;耐药类型以耐多药和利福平耐药为主。结论海南省耐药结核病尤其是耐多药结核病形势不容乐观;乙胺丁醇、卡那霉素、卷曲霉素、丙硫异烟胺在海南地区仍有很大的临床抗结核价值,临床上应予以关注;应继续加强耐药结核病发现力度和防控策略,遏制耐药结核病流行。
Objective To analyze the types and distribution of 502 strains of tuberculosis in Hainan Tuberculosis Hospital and provide a scientific basis for the development of drug-resistant tuberculosis treatment programs. Methods A total of 502 strains of Mycobacterium tuberculosis isolates, which were isolated and cultured from sputum from January 2014 to December 2016, were collected. Eight anti-tuberculosis drugs (isoniazid, rifampin, ethylamine Butanol, streptomycin, kanamycin, capreomycin, ofloxacin, and propylthiouracil), and the results were analyzed. Results The total drug resistance rate was 43.6% (219/502). The total drug resistance rate in 2015 and 2016 was significantly higher than that in 2014 (= 10.136, P = 0.001; = 8.56, P = 0.003) % (128/502). There was no significant change in the multi-drug resistance in the recent 3 years (= 3.297, P> 0.05). The antimicrobial resistance rates were in the order of rifampicin> isoniazid> streptomycin> Ofloxacin> ethambutol> kanamycin> capreomycin> propylthiouracil; types of resistance were multidrug-resistant and rifampicin-resistant. Conclusions The situation of drug-resistant TB in Hainan Province, especially MDR-TB is not optimistic. Ethambutol, kanamycin, capreomycin and propylthiouracil still have great clinical anti-TB value in Hainan. Clinically Should be concerned about; should continue to strengthen efforts to detect drug-resistant TB and prevention and control strategies to curb the epidemic of drug-resistant TB.