First-line drug resistance of Mycobacterium tuberculosis isolated in Southwest China
CHEN Xing1, LI Yu-qing1, WAN Li3, LIU Hai-can2, ZHAO Xiu-qin2, GUAN Cha-xiang3, WAN Kang-lin1, 2, YUAN Xiu-qin1
1. School of Public Health, University of South China, Hengyang 421001, China; 2. State Key Laboratory for Infectious Diseases Prevention and Control,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China; 3. Department of Physiology, Xiangya Medical School, Central South University, Changsha 410000, China
Abstract:The drug-resistance and its influencing factors of clinical isolates of Mycobacterium tuberculosis (M. tuberculosis) in Southwest China were investigated in this study, for providing the basic scientific reference for the prevention and control of tuberculosis (TB). A total of 500 clinical isolates of M. tuberculosis from the sputum specimens of the patients with TB in 2006—2013 were collected in the four provinces of the southwestern China (Guizhou, Guangxi, Sichuan and Chongqing). The drug susceptibility of the strains to the four drugs was tested with the drug susceptibility test (DST) of the proportion method. Statistical analyses were carried out by using χ2 analysis and logistic regression analysis. Among all the 500 clinical isolates of M. tuberculosis, the percentages of drug resistance to INH, RFP, EMB and SM were 30.40%, 26.00%, 9.80% and 24.40%, respectively. The total drug resistant rate and multi drug-resistant (MDR) rate were 40.60% and 27.20%, respectively. The total drug resistant rate and MDR rate in Guizhou, Sichuan, Guangxi and Chongqing were 64.10% and 46.15%, 59.54% and 51.90%, 28.88% and 14.97%, 20.19% and 3.85%, respectively. There were significant differences (P<0.05) in drug-resistant rate to INH, RFP, EMB, SM, the total drug resistance and MDR in these areas. Logistic regression analysis showed that the influence factors were case types and area (P<0.05). The drug resistance of tuberculosis was very severe in southwest China, especially in Guizhou and Sichuan. For guiding the clinical medication to prevention and control of drug-resistant TB, we should be more attention to the surveillance of drug resistance of M. tuberculosis.
[1] WHO. Global tuberculosis report 2015[M]. Geneva:World Health Organization, 2015. [2] Chen W, Xia YY, Li T, et al. Analysis for the globaI and China TB epidemic situation in 2015[J]. J Tuber Lung Heal, 2016, 5(1):32-36. doi:10.3969/j.issn.2095-3755.2016.01.010 (in Chinese) 陈伟,夏愔愔,李涛,等. 2015年全球及中国结核病疫情形势分析[J]. 结核病与肺部健康杂志,2016,5(1):32-36. [3] WHO. Guidelines for surveillance of drug resistant in tuberculosis[M]. Geneva:World Health Organization, 2009. [4] Xu B, Hu Y, Wang WB, et al. Molecular-epidemiological study on the transmission of drug resistant tuberculosis and its influencing factors in rural areas of eastern China[J]. Chin J Epidemiol, 2010, 31(5):525-529. doi:10. 3760/cma.j.issn.0254-6450.2010.05.012 (in Chinese) 徐飚,胡屹,王伟炳,等. 华东农村地区耐药结核病传播及其影响因素的分子流行病学研究[J]. 中华流行病学杂志,2010,31(5):525-529. [5] Xiao DL. The baseline survey on drug resistant tuberculosis in China (2007-2008)[M]. Beijing:People’s Medical Publishing House, 2010:23-37. (in Chinese) 肖东楼. 全国结核病耐药性基线调查报告(2007-2008)[M]. 北京:人民卫生出版社,2010:23-37. [6] Hu ZQ, Liu YW, Zhou W, et al. Relationship between rpoB mutations and the levels of rifampicin resistance in M.tuberculosis [J]. Chin J Zoonoses, 2016, 32(1):39-44. doi:10. 3969/j.issn.1002-2694.2016.01.009 (in Chinese) 胡族琼, 刘燕文, 周文, 等. 结核分枝杆菌 rpoB 基因突变特征与利福平耐药水平关系的研究[J]. 中国人兽共患病学报, 2016, 32 (1):39-44. [7] Su R, Ou WZ, Wang Y, et al. Detection of mutations associated with streptomycin and ethambutol resistance in Mycobacterium tuberculosis clinical isolates[J]. Chin J Zoonoses, 2016, 32(8):760-764. doi:10. 3969/j.issn.1002-2694.2016.08.015 (in Chinese) 孙荣, 欧维正, 王燕, 等. 贵阳市结核分枝杆菌链霉素和乙胺丁醇耐药相关基因突变的检测与分析[J]. 中国人兽共患病学报, 2016, 32 (8):760-764. [8] Ou WZ, Chen ZH, Chen J, et al. Determination of resistance genes KatG and inhA in Mycobacterium tuberculosis isolates from Guizhou Province by gene chip[J]. Chin J Zoonoses, 2015, 31(7):655-658. doi:10. 3969/cjz.j.issn.1002-2694.2015.07.013 (in Chinese) 欧维正, 陈峥宏, 陈静, 等. 基因芯片检测贵州省结核分枝杆菌耐药基因 KatG 和 inhA [J]. 中国人兽共患病学报, 2015, 31 (7):655-658. [9] Li Q, Wang XM, He HB. WHO sample survey on drug resistant tuberculosis in Zhejiang, China[J]. Chin J Tubere Respir Dis, 2000, 23(12):718-721. (in Chinese) 李群, 王晓萌, 何海波. WHO浙江省结核病耐药监测研究报告[J]. 中华结核和呼吸杂志, 2000, 23 (12):718-721. [10] Wang XL, Wang XP, Xiao HX, et al. Survey of drug-resistant Mycobacterium tuberculosis in Ningxia[J]. Chin J Tubere Respir Dis, 2015, 38(10):738-740. doi:10. 3760/cma.j. ssn.1001-0939.2015.10.004 (in Chinese) 王晓林, 王晓平, 肖慧霞, 等. 宁夏地区结核分枝杆菌耐药情况调查[J]. 中华结核和呼吸杂志, 2015, 38 (10):738-740. [11] Zhao Y, Xu S, Wang L, et al. National survey of drug-resistant tuberculosis in China[J]. N Engl J Med, 2012, 366 (23):2161-2170. doi:10.1056/NEJMoa1108789 [12] Wang XY, Zhao YL, Pang Y, et al. Genotyping and drug resistance analysis of M. tuberculosis clinical isolates in Chongqing[J]. Chin J Antitubercul, 2013, 35(9):668-672. (in Chinese) 汪晓艳, 赵雁林, 逄宇, 等. 重庆市结核分枝杆菌临床分离株的基因分型及相关耐药性分析[J]. 中国防痨杂志, 2013, 35 (9):668-672. [13] Wang XP, Pang Y, Zhao X, et al. Genotyping and drug resistance analysis of Mycobacterium tuberculosis in Ningxia[J]. Chin J Antitubercul, 2013, 35(9):655-659. (in Chinese) 王晓平, 逄宇, 赵晓, 等. 宁夏回族自治区结核分枝杆菌基因分型及与耐药性关系的研究[J]. 中国防痨杂志, 2013, 35 (9):655-659.