【作者】 李静； 沈鑫； 张阳奕； 孙丕； 江渊； 武洁； 王莉莉； 桂晓虹； 梅建； 高谦； 罗涛； 杨崇广；

【Author】 Department of TB Control,Shanghai Municipal Center for Disease Control and Prevention.Shanghai,200336, LI Jing,SHEN Xin,ZHANG Yangyi,LUO Tao,YANG Chongguang,SUN Pi,JIANG Yuan,WU Jie,WANG Lili, GUI Xiaohong,GAO Qian,MEI Jian.

【机构】 上海市疾病预防控制中心结核病防治科； 复旦大学上海医学院医学分子病毒学重点实验室；

【摘要】 目的了解上海地区肺结核病患者氧氟沙星耐药的流行情况。方法收集2009年-2010年上海地区各区县结核病定点医院痰培养阳性病例的临床菌株,进行一线抗结核药物敏感性检测及氧氟沙星敏感性检测,对氧氟沙星耐药菌株进行gyrA、gyrB基因耐药决定区测序分析。结果共收集临床菌株598株,其中耐药菌株447株,全敏感菌株151株。在447株耐一线药物结核分枝杆菌菌株中,72株(16.1%)对氧氟沙星耐药,MDR-TB耐氧氟沙星44株,占MDR-TB菌株的39.6%(44/111)。对一线药物全敏感的151株菌株中发现4株(2.6%)耐氧氟沙星。氧氟沙星耐药患者中初治结核病人占51.3%(39/76)。76株氧氟沙星耐药菌株的gyrA、gyrB基因耐药决定区序列分析显示有62株(81.6%)发生耐药突变。结论上海地区MDR-TB病人氧氟沙星耐药情况比较严重,一线药物全敏感肺结核病患者氧氟沙星耐药水平较低。氧氟沙星耐药在结核病患者中存在近期传播,需要加强结核病人的早期发现和治疗管理。更多还原

【Abstract】 Objective To investigate the prevalence of Ofloxacin resistance among the tuberculosis patients in shanghai.Methods We evaluated first-line drug and Ofloxacin susceptibility using the proportion method in isolates obtained from tuberculosis patients detected at each district TB hospital in Shanghai from 2009 to 2010. The sequence of the QRDR in gyrA and gyrB genes of the fluoroquinolone(FQ)-resistant isolates were detected with DNA direct sequencing technique.Results 598 tuberculosis were collected from the clinical trials,which of 447 isolates were drug-resistant TB and 151 isolates were pan-susceptible to first-line drugs.Of the 447 isolates drug-resistant TB from the clinical trials,72(16.1%)were resistant to Ofloxacin.Ofloxacin resistance were detected in 2.6%(4/151) of strains pan-susceptible to first-line drugs.The Ofloxacin resistance rate of the MDR-patient was 39.6%(44/111).The Ofloxacin resistance rate of new cases was 51.3%(39/76 ).Mutation in QRDR of the gyrA and gyrB genes were found 62(81.6%) in 76 of phenotypically fluoroquinolone-resistant isolates.Conclusions The resistance level to Ofloxacin in TB patients was low.However,Ofloxacin resistance in MDR-patients was high.The prevalence of resistance to Ofloxacin was occurred in TB patients recently.It is necessary to strengthen the TB control program for TB patients in Shanghai.更多还原