四川地区儿童分枝杆菌感染及耐药情况分析

doi:10.19871/j.cnki.xfcrbzz.2023.01.008

摘要/Abstract

摘要： 目的探讨四川地区儿童分枝杆菌感染及耐药特点,为该地区儿童结核病的防治提供数据支撑。方法对2019年1月至2021年3月成都市公共卫生临床医疗中心结核病科收治的年龄小于15岁分枝杆菌感染儿童的各类标本进行分枝杆菌分离培养,培养阳性菌株进行银科微孔板法（48孔）快速药敏试验,微孔板法药敏试验共检测链霉素(SM)、异烟肼（INH）、利福平（RFP）、乙胺丁醇（EMB）、利福喷丁（RFT）、左氧氟沙星（LFX）、阿米卡星（AMK）、卷曲霉素（CPM）、丙硫异烟胺（PTO）、帕司烟肼（PI）、莫西沙星（MFX）、对氨基水杨酸（PAS）、克拉霉素（CLR）、利福布汀（RFB）、卡那霉素（KAN）、氯法齐明（CFZ）16种抗结核药物。回顾性分析入组患儿的菌种分布、耐药情况和流行病学特点。结果 200例结核分枝杆菌感染的儿童中,共分离出人型结核分枝杆菌(MTB)194株（97.00%）,非结核分枝杆菌(NTM)6株（3.00%）。194株MTB对至少1种抗结核药物耐药43株,总耐药率为22.16%;至少同时对INH和RFP耐药10株,耐多药（MDR）率为5.15%,未发现广泛耐药（XDR）菌株。单一耐药模式中以单耐INH为主,多耐药模式中非MDR菌株以RFP+RFB+RFT和INH+PI耐药为主。耐药顺位是INH（12.37%）、RFP（9.79%）、RFT（9.79%）、RFB（7.22%）、PI（5.67%）、SM（4.12%）、PAS（2.58）、CPM（2.06）。敏感组与耐药组患儿民族（汉族）、年龄（7~11岁和12~14岁）、居住地（藏族地区）构成比方面比较差异有统计学意义（P<0.05）。结论四川地区儿童结核患者INH耐药率最高,四川藏区患儿更易发生耐药结核。

关键词: 儿童, 结核分枝杆菌, 微孔板法快速药物敏感试验, 流行病学, 耐药结核病

Abstract: Objective Understand the situation of mycobacterial infection and drug resistance in children in Sichuan, provide data support for the prevention and management of tuberculosis in children in the region, and provide help for clinical treatment. Method From January 2019 to March 2021,various specimens of children younger than 15 years old admitted to the tuberculosis area and tuberculosis clinic of Chengdu Public Health Clinical Medical Center were isolated and cultured for mycobacteria, and the positive strains were cultured for silver micropores Plate method (48 holes) rapid drug susceptibility test, Microplate method drug susceptibility test includes strain identification (TCH, PNB) and streptomycin (SM), isoniazid (INH), rifampicin (RFP), ethambutol (EMB), rifapentin (RFT), levofloxacin (LFX), amikacin (AMK), capreomycin (CPM), prothionamide (PTO), lectra pasiniazid (PI), moxifloxacin (MFX), P-Amino Water Susceptibility results of 16 drugs including salicylic acid (PAS), clarithromycin (CLR), rifabutin (RFB), kanamycin (KAN), and clofazimine (CFZ). The distribution, drug resistance and epidemiological characteristics of mycobacterial culture-positive children were retrospectively analyzed. Result Among the 200 strains of mycobacteria in children, 194 strains (97.00%) of Mycobacterium tuberculosis (MTB) were found, and 6 strains (3.00%) of nontuberculous mycobacteria (NTM). The results of MTB drug susceptibility showed that 43 of the 194 MTB strains were resistant to at least one anti-tuberculosis drug, with a total resistance rate of 22.16%; 10 strains were resistant to INH and RFP (MDR) at the same time, with a multidrug resistance rate of 5.15%, no extensively drug-resistant (XDR) strains were found. Mono-resistance was mainly mono-resistance to INH, and multi-resistance was mainly RFP+RFB+RFT and INH+PI. The resistance rankings were INH (12.37%), RFP (9.79%), RFT (9.79%), RFB (7.22%), PI (5.67%), SM (4.12%), PAS (2.58), CPM (2.06) main. There were significant differences in ethnicity (Han nationality), age (7-11 years old and 12-14 years old), and residence (Tibetan area) between the sensitive group and the resistant group (P<0.05). Conclusion The INH drug resistance rate of pediatric tuberculosis patients in Sichuan is the highest, and children in Tibetan areas in Sichuan are more likely to develop drug-resistant tuberculosis. This study provides a theoretical basis for the prevention and treatment of pediatric tuberculosis in Sichuan.

Key words: Children, Mycobacterial infection, Rapid microplate test, Epidemiology, Drug-resistant tuberculosis

中图分类号:

R725.1

徐园红, 吴张君, 罗槑, 朱玛, 王冬梅, 曾沛斌. 四川地区儿童分枝杆菌感染及耐药情况分析[J]. 新发传染病电子杂志, 2023, 8(1): 39-43.

Xu Yuanhong, Wu Zhangjun, Luo Mei, Zhu Ma, Wang Dongmei, Zeng Peibin. The analysis of mycobacterial infection and drug resistance among children in Sichuan[J]. Electronic Journal of Emerging Infectious Diseases, 2023, 8(1): 39-43.

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