论文部分内容阅读
为了解天津地区临床分离的非结核分枝杆菌(NTM)的感染趋势及耐药情况,收集2011年1月1日至2015年12月31日天津市结核病控制中心及15个区(县)结核病防治机构(或定点医院)及监狱医院送检的新发痰菌培养阳性患者所获得的全部菌株,采用硝基苯甲酸(PNB)和噻吩2羧酸肼(TCH)进行菌种鉴定,对NTM菌株采用比例法进行链霉素(Sm)、异烟肼(INH)、利福平(RFP)、乙胺丁醇(EMB)、氧氟沙星(Ofx)和卡那霉素(Km)等6种抗结核药物的药物敏感性试验(简称“药敏试验”).结果显示,分离得到的3972株分枝杆菌中结核分枝杆菌有3899株(98.16％),NTM有73株(1.84％).NTM的总耐药率为98.63％(72/73),INH、Sm、RFP、EMB、Ofx、Km耐药率分别为94.52％(69/73)、80.82％(59/73)、56.16％(41/73)、64.38％(47/73)、58.90％(43/73)和73.97％(54/73).分离的NTM对6种药物全耐药的有21株,耐5种药物的有17株,耐5种和6种药物的菌株占52.05％(38/73).耐药谱分析显示,耐6种药物的菌株最多,占28.77％(21/73),其次为耐3种药物[Sm+IN+Km;10.96％(8/73)]和耐5种药物[Sm+ INH+RFP+EMB+ Km;9.59％ (7/73)],所有耐药组合中均含有INH.对6种药物耐药情况进行趋势检验显示,EMB的耐药率[2011-2015年:93.33％(14/15)～42.86％(9/21)]呈不断降低的趋势(x2=13.32,P=0.001),其他5种药物耐药率未见变化.“,”The aim of this study was to analyze the infection tendency and drug resistance of nontuberculous mycobacteria (NTM) isolated from 2011 to 2015 in Tianjin.From January 1,2011 to December 31,2015,all the sputum culture-positive strains from new tuberculous (TB) patients in the Tianjin Center for Tuberculosis Control and the 15 TB control institutions in municipality and country (or designated hospitals) and the prison hospitals were collected.Para-nitro benzoic acid (PNB) and Thiophene-2-carboxylic acid hydrazide (TCH) were used to identify the species.Ratio drug sensitive test was used to analysis the drug resistant rate of the NTM stains.Six drugswere tested,including Streptomycin (Sm),isoniazid (INH),rifampicin (RFP),ethambutol (EMB),ofloxacin(Ofx),and kanamycin (Km).Results showed that in the 3972 isolated strains,there were 3899 (98.16％) strainsof MTB and 73 (1.84％) strains of NTM.The overall resistance rate of NTM was 98.63％ (72/73).The drug re-sistance rate of NTM to INH,Sm,RFP,EMB,Ofx,and Km were 94.52％ (69/73),80.82％ (59/73),56.16％(41/73),64.38％ (47/73),58.90％ (43/73),and 73.97％ (54/73).There were 21 strains resistant to all of thesix drugs,and 17 strains resistant to five drugs,accounting for 52.06％ (38/73) in all NTM.Drug resistance spectrum analysis indicated that the most common drug-resistant strains were resistant to all of the six drugs (28.77％(21/73)),followed by Sm+ IN+Km (10.96％ (8/73)) and Sm+ INH+RFP+EMB+Km (9.59％ (7/73)).INH was included in all above drug-resistant combination.The rate of EMB resistance decreased from 93.33％(14/15) in 2011 to 42.86％ (9/21) in 2015 (x2 =13.32,P=0.001),while the resistance rate of other five drugswere not significantly changed from 2011 to 2015.