2020—2022年重庆市耐多药结核病患者氟喹诺酮类药物耐药情况及影响因素分析

doi:10.19983/j.issn.2096-8493.20230099

结核与肺部疾病杂志 ›› 2023, Vol. 4 ›› Issue (6): 475-479.doi: 10.19983/j.issn.2096-8493.20230099

2020—2022年重庆市耐多药结核病患者氟喹诺酮类药物耐药情况及影响因素分析

游国庆, 刘文果, 冯鑫, 余敏, 石林, 胡彦()

重庆市结核病防治所结核病参比实验室,重庆 400050

收稿日期:2023-08-30 出版日期:2023-12-20 发布日期:2023-12-18
通信作者: 胡彦,Email:huyanz025@163.com
作者简介:注:刘文果与游国庆对本文有同等贡献,为并列第一作者
基金资助:
重庆市科卫联合医学科研项目(2022MSXM102);重庆市科卫联合医学科研项目(2022MSXM066);重庆市首批公共卫生重点学科(专科)((2022)72)

Analysis of fluoroquinolones resistance in multidrug-resistant tuberculosis patients in Chongqing from 2020 to 2022

You Guoqing, Liu Wenguo, Feng Xin, Yu Min, Shi Lin, Hu Yan()

Tuberculosis Reference Laboratory, Chongqing Institute for Tuberculosis Control, Chongqing 400050, China

Received:2023-08-30 Online:2023-12-20 Published:2023-12-18
Contact: Hu Yan, Email: huyanz025@163.com
Supported by:
Chongqing Science and Health Joint Medical Research Project(2022MSXM102);Chongqing Science and Health Joint Medical Research Project(2022MSXM066);The First Batch of Key Public Health Disciplines (Junior Colleges) in Chongqing((2022)72)

摘要/Abstract

摘要：

目的: 分析重庆市耐多药结核病(MDR-TB)患者对氟喹诺酮类药物(FQs)的耐药情况及影响因素。方法: 采用简单随机抽样的方法,选取2020年1月至2022年12月重庆市39个区(县)的165例MDR-TB患者作为研究对象,并收集研究对象基本信息。165株分离自研究对象的耐多药结核分枝杆菌(MDR-MTB)均经菌种鉴定和比例法药物敏感性试验确证。采用微量肉汤稀释法,检测临床分离菌株对氧氟沙星(Ofx)、左氧氟沙星(Lfx)和莫西沙星(Mfx)的药物敏感性,分析菌株对FQs的耐药情况及相关影响因素。结果: 165株MDR-MTB分离株对FQs的总耐药率为37.6%(62/165),对Ofx、Lfx和Mfx的耐药率分别为37.6%(62/165)、37.0%(61/165)和29.7%(49/165)。多因素logistic回归分析显示,无FQs用药史是FQs耐药的保护因素[OR(95%CI)=0.348(0.169~0.717)]。结论: 重庆地区MDR-TB患者FQs耐药率较高,有FQs用药史的患者发生FQs耐药的风险较高。

关键词: 分枝杆菌,结核, 喹诺酮类, 抗药性,多药, 危险因素

Abstract:

Objective: To analyze the resistance of multidrug-resistant tuberculosis (MDR-TB) patients to fluoroquinolones (FQs) and its influencing factors in Chongqing. Methods: A simple random sampling method was used in 165 MDR-TB patients from 39 districts (counties) in Chongqing from January 2020 to December 2022 (study subjects), and basic information of the study subjects was collected. All the 165 strains of multidrug-resistant Mycobacterium tuberculosis (MDR-MTB) isolated from the study subjects were confirmed through strain identification and proportional drug sensitivity testing. Using the micro broth dilution method, the drug sensitivities of clinical isolates to ofloxacin (Ofx), levofloxacin (Lfx), and moxifloxacin (Mfx) were tested, and the drug resistance of the strains to FQs and related influencing factors were analyzed. Results: The total resistance rate of 165 MDR-MTB isolates to FQs was 37.6% (62/165), and the resistance rates to Ofx, Lfx, and Mfx were 37.6% (62/165), 37.0% (61/165), and 29.7% (49/165), respectively. Multivariate logistic regression analysis showed that no history of FQs medication was a protective factor for FQs resistance (OR (95%CI)=0.348 (0.169-0.717)). Conclusion: The FQs resistance rate of MDR-TB patients in Chongqing is relatively high, and patients with a history of FQs medication have a higher risk of FQs resistance.

Key words: Mycobacterium tuberculosis, Quinolones, Drug resistance, multiple, Risk factors

中图分类号:

R521
R825.2

游国庆, 刘文果, 冯鑫, 余敏, 石林, 胡彦. 2020—2022年重庆市耐多药结核病患者氟喹诺酮类药物耐药情况及影响因素分析[J]. 结核与肺部疾病杂志, 2023, 4(6): 475-479. doi: 10.19983/j.issn.2096-8493.20230099

You Guoqing, Liu Wenguo, Feng Xin, Yu Min, Shi Lin, Hu Yan. Analysis of fluoroquinolones resistance in multidrug-resistant tuberculosis patients in Chongqing from 2020 to 2022[J]. Journal of Tuberculosis and Lung Disease, 2023, 4(6): 475-479. doi: 10.19983/j.issn.2096-8493.20230099

图/表 4

表1

表2

表3

表4

耐多药结核病患者发生氟喹诺酮类药物耐药影响因素的多因素logistic回归分析

因素	β值	s $x ˉ$ 值	Wald χ²值	P值	OR(95%CI)值
无氟喹诺酮类药物用药史	-1.506	0.369	8.201	0.004	0.348(0.169~0.717)
链霉素耐药	0.800	0.398	4.037	0.045	2.226(1.020~4.859)
职业(以“家务及待业组”为参照)
农民	0.095	0.529	0.033	0.857	1.100(0.390~3.105)
民工	2.434	1.217	3.999	0.046	11.408(1.050~123.984)
其他^a	0.612	0.645	0.898	0.343	1.843(0.520~6.532)

表4

参考文献 17

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氟喹诺酮类药物	最低抑菌浓度(株)											临界浓度 (μg/ml)	耐药 [株(耐药率,%)]
氟喹诺酮类药物	≤0.03 μg/ml	0.06 μg/ml	0.125 μg/ml	0.25 μg/ml	0.5 μg/ml	1 μg/ml	2 μg/ml	4 μg/ml	8 μg/ml	16 μg/ml	≥32 μg/ml	临界浓度 (μg/ml)	耐药 [株(耐药率,%)]
氧氟沙星	0	0	2	11	64	21	5	31	17	11	3	2	62(37.6)
左氧氟沙星	0	2	5	60	30	7	19	25	14	3	0	1	61(37.0)
莫西沙星	1	6	37	48	12	12	27	16	5	1	0	1	49(29.7)

因素	合计 (165例)	FQs^a耐药 (62例)	FQs敏感 (103例)	OR (95%CI)值	P值
性别[例(构成比,%)]
女性	34(20.6)	11(17.7)	23(22.3)	1.000
男性	131(79.4)	51(82.3)	80(77.7)	1.333(0.599~2.966)	0.480
年龄组[例(构成比,%)]
≤40岁	37(22.4)	17(27.4)	20(19.4)	1.000
41~59岁	68(41.2)	23(37.1)	45(43.7)	0.601(0.265~1.364)	0.222
≥60岁	60(36.4)	22(35.5)	38(36.9)	0.681(0.296~1.567)	0.365
治疗分类[例(构成比,%)]
初治	97(58.8)	34(54.8)	63(61.2)	1.000
复治	68(41.2)	28(45.2)	40(38.8)	1.297(0.685~2.455)	0.424
行政区划[例(构成比,%)]
主城区	76(46.1)	25(40.3)	51(49.6)	1.000
渝东北	42(25.4)	16(25.8)	26(25.2)	1.255(0.572~2.753)	0.570
渝东南	47(28.5)	21(33.9)	26(25.2)	1.648(0.780~3.482)	0.189
职业[例(构成比,%)]
农民	110(66.7)	39(62.9)	71(68.9)	1.491(0.576~3.857)	0.408
家务及待业	26(15.8)	7(11.3)	19(18.4)	1.000
民工	6(3.6)	5(8.1)	1(1.0)	13.571(1.340~137.454)	0.035
其他^b	23(13.9)	11(17.7)	12(11.7)	2.488(0.756~8.193)	0.130
糖尿病[例(构成比,%)]
无	132(80.0)	53(85.5)	79(76.7)	1.000
有	33(20.0)	9(14.5)	24(23.3)	0.559(0.241~1.297)	0.172
尘肺[例(构成比,%)]
无	157(95.1)	59(95.2)	98(95.1)	1.000
有	8(4.9)	3(4.8)	5(4.9)	0.997(0.230~4.323)	1.000
FQs用药史[例(构成比,%)]
否	119(72.1)	37(59.7)	82(79.6)	1.000
是	46(27.9)	25(40.3)	21(20.4)	2.638(1.313~5.303)	0.006
耐药情况[例(耐药率,%)]
链霉素	110(66.7)	49(79.0)	61(59.2)	2.595(1.255~5.368)	0.009
乙胺丁醇	19(11.5)	11(17.7)	8(7.8)	2.561(0.969~6.771)	0.052
对氨基水杨酸	43(26.1)	16(25.8)	27(26.2)	0.979(0.477~2.009)	0.954
阿米卡星	18(10.9)	9(14.5)	9(8.7)	1.774(0.663~4.742)	0.249

变量	赋值
氟喹诺酮类药物耐药情况	0=敏感;1=耐药
氟喹诺酮类药物用药史	0=无;1=有
链霉素耐药情况	0=敏感;1=耐药
职业	0=家务及待业;1=农民;2=民工;3=其他^a

2020—2022年重庆市耐多药结核病患者氟喹诺酮类药物耐药情况及影响因素分析

Analysis of fluoroquinolones resistance in multidrug-resistant tuberculosis patients in Chongqing from 2020 to 2022

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