Analysis of Mycobacterium tuberculosis drug resistance in drug-resistance monitoring sites in Chongqing Municipality (2014-2019)

doi:10.3969/j.issn.2096-8493.20210039

Abstract

Abstract:

Objective To investigate the situation of Mycobacterium tuberculosis drug resistance in the tuberculosis drug resistance monitoring sites in Chongqing Municipality and provide reference for formulating future TB control policy. Methods The information of 935 tuberculosis patients from the two surveillance sites (Fengdu county and Fengjie County) of Chongqing from 2014 to 2019 were collected. Mycobacterium tuberculosis complex isolates from those patients were tested for drug resistance of isoniazid (INH), rifampicin (RFP), streptomycin (Sm), ethambutol (EMB),ofloxacin (Ofx) and kanamycin (Km). Results Among 953 Mycobacterium tuberculosis complex isolates, 797 strains (83.63%) were isolated from newly treated patients and 156 (16.37%) were from re-treated patients. Drug resistance rate among new and retreated patients were 13.30% (106/797) and 24.36% (38/156) respectively, and the total drug resistance rate was 15.11% (144/953).The drug resistance rates of INH, RFP and Sm in re-treated patients from 2014 to 2019 were 13.46% (21/156), 9.62% (15/156) and 12.18% (19/156), respectively, which were significantly higher than those in the new patients (6.65% (53/797), 3.51% (28/797) and 6.90% (55/797)), with statistical significance (χ ²=8.452,P=0.004;χ²=11.276,P=0.001;χ²=5.076,P=0.024). Conclusion The drug resistance rate of the retreated patients was higher than that of the newly treated patients in Chongqing tuberculosis drug resistance surveillance sites, and the drug resistance was controlled to a certain level after the implementation of “trinity of tuberculosis care provider” in tuberculosis management.

Key words: Mycobacterium tuberculosis, Drug resistance, Monitoring, Chongqing City

FENG Xin, HU Yan, SHEN Jing, ZHAN Jian. Analysis of Mycobacterium tuberculosis drug resistance in drug-resistance monitoring sites in Chongqing Municipality (2014-2019)[J]. Journal of Tuberculosis and Lung Disease , 2021, 2(3): 251-255. doi: 10.3969/j.issn.2096-8493.20210039

Figures/Tables 5

References 14

[1]	World Health Organization. Golobal tuberculosis report 2020. Geneva: World Health Organization, 2020.
[2]	Wu B, Yu Y, Xie W, et al. Epidemiology of tuberculosis in Chongqing, China: a secular trend from 1992 to 2015. Sci Rep, 2017, 7(1):7832. doi: 10.1038/s41598-017-07959-2. doi: 10.1038/s41598-017-07959-2 URL
[3]	赵雁林, 逄宇. 结核病实验室检验规程. 北京: 人民卫生出版社, 2015:45-65.
[4]	赵雁林. 结核病实验室质量保证手册. 北京: 人民卫生出版社, 2017:45-55.
[5]	白桦, 郭靖玮, 胡培磊, 等. 2014—2018年湖南省耐药监测点结核分枝杆菌耐药监测结果分析. 中国防痨杂志, 2021, 43(4):364-369. doi: 10.3969/j.issn.1000-6621.2021.04.012. doi: 10.3969/j.issn.1000-6621.2021.04.012
[6]	胡彦, 杨春, 冯鑫, 等. 重庆市耐多药患者肺结核可疑患者药敏结果分析. 重庆医科大学学报, 2018, 43(7):923-926. doi: 10.13406/j.c nki. Cyx b.001210. doi: 10.13406/j.c nki. Cyx b.001210
[7]	王晓英, 朱大冕, 刘洁, 等. 重庆市肺结核患者异烟肼与丙硫异烟胺耐药状况分析. 中国人兽共患病学报, 2019, 35(2):173-178. doi: 10.3969j.issn.1002-2694.2018.00. 229. doi: 10.3969j.issn.1002-2694.2018.00. 229
[8]	重庆市卫生健康委. 重庆市遏制结核病行动实施方案(2019-2022年). 国卫疾控发﹝2019﹞41号. 2020-01-20.
[9]	徐彩红, 周向梅, 范伟兴, 等. 我国结核病防治主要成就回眸及亟待解决的问题与建议. 中国防痨杂志, 2020, 42(12):1263-1267. doi: 10.3969/j.issn.1000-6621.2020.12.002. doi: 10.3969/j.issn.1000-6621.2020.12.002
[10]	高谦, 梅建. 传播才是造成我国结核病高耐药率的主要原因. 中国防痨杂志, 2015, 37(11):1091-1096. doi: 10.3969/j.issn.1000-6621.2015.11.002. doi: 10.3969/j.issn.1000-6621.2015.11.002
[11]	Yang C, Luo T, Shen X, et al. Transmission of multidrug-resistant Mycobacterium tuberculosis in Shanghai, China: a re-trospective observational study using whole-genome sequencing and epidemiological investigation. Lancet Infect Dis, 2017, 17(3):275-284. doi: 10.1016/S1473-3099(16)30418-2. doi: 10.1016/S1473-3099(16)30418-2 URL
[12]	高媛, 张书, 龙波, 等. 2018年四川省4865例涂阳结核患者耐药分析. 职业卫生与病伤, 2020, 35(5):278-284.
[13]	张天华, 刘卫平, 李妍, 等. 陕西省肺结核耐药性监测分析. 中国热带医学, 2017, 17(3):226-230. doi: 10.13604/j.cnki.461064/r.2017.03.04. doi: 10.13604/j.cnki.461064/r.2017.03.04
[14]	宋克玉, 张琴, 王雯菁, 等. 2017—2019年南京市1719株分枝杆菌耐药情况分析. 中国防痨杂志, 2020, 42(11):1214-1220. doi: 10.3969/j.issn.1000-6621.2020.11.013. doi: 10.3969/j.issn.1000-6621.2020.11.013

区县	初治			复治			合计
区县	耐药例数	总例数	耐药率(%)	耐药例数	总例数	耐药率(%)	耐药例数	总例数	耐药率(%)
丰都	35	370	9.46	20	76	26.32	55	446	12.33
奉节	71	427	16.63	18	80	22.50	89	507	17.55
合计	106	797	13.30	38	156	24.36	144	953	15.11
χ²值			8.833			0.308			5.045
P值			0.003			0.579			0.025

特征	耐药例数	总数	耐药率(%)	χ²值	P值
性别				2.391	0.122
男	116	719	16.13
女	28	234	11.97
年龄组(岁)				0.071	0.965
0~14	1	6	1/6
15~59	94	614	15.31
60~90	49	333	14.71
职业				0.071	0.790
农民	112	733	15.28
其他	32	220	14.55
糖尿病病史				0.256	0.613
有	13	76	17.11
无	131	877	14.94

年份	初治患者					复治患者
年份	耐药例数	耐多药例数	总例数	耐药率 (%)	耐多药率(%)	耐药例数	耐多药例数	总例数	耐药率 (%)	耐多药率(%)
2014	7	1	69	10.14	1.45	3	0	9	3/9	0.00
2015	8	4	99	8.08	4.04	10	3	24	41.67	12.50
2016	23	6	147	15.65	4.08	7	3	38	18.42	7.89
2017	32	6	160	20.00	3.75	7	1	18	38.59	5.56
2018	16	2	134	11.94	1.49	6	0	25	24.00	0.00
2019	20	2	188	10.64	1.06	5	1	42	11.90	2.38
χ²值				0.474	0.562				13.472	2.953
P值				0.491	0.453				0.000	0.086

耐药种类	初治(797例)		复治(156例)		合计(953例)
耐药种类	耐药例数	耐药率(%)	耐药例数	耐药率(%)	耐药例数	耐药率(%)
单耐药
INH	15	1.88	7	4.49	22	2.31
RFP	6	0.75	3	1.92	9	0.94
Sm	24	3.01	5	3.21	29	3.04
EMB	0	0.00	0	0.00	0	0.00
Ofx	16	2.01	2	1.28	18	1.89
Km	2	0.25	0	0.00	2	0.21
其他耐药
PDR	11	1.38	9	5.77	20	2.10
RR	7	0.88	7	4.49	14	1.47
MDR	21	2.63	8	5.13	29	3.04
pre-XDR	3	0.38	4	2.56	7	0.73
XDR	1	0.13	0	0.00	1	0.10

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