摘要
目的:分析医院内结核分枝杆菌耐药现状与可能耐药的影响因素,供临床更好地制定耐药结核病的控制预防策略参考。方法:选取2014年1—12月间医院结核分枝杆菌培养结果显阳性者,且具有药敏实验结果的病例115例;收集临床资料,分析结核分枝杆菌对链霉素(SM,S)、异烟肼(INH,H)、利福平(RFP,R)、乙胺丁醇(EMB,E)和吡嗪酰胺(PZA,Z)5种一线抗结核药物的耐药情况,并了解结核菌耐药可能的影响因素。结果:115例结核分枝杆菌感染患者中,初治患者80例(69.57%),复治患者35例(30.43%),初、复治患者对H的任一耐药率、单耐药率均最高,复治患者对S、H、R、Z任一耐药率均明显高于初治患者(均P<0.05);初、复治患者单耐药率比较其差异无统计学意义(P>0.05);初治患者表现为1种耐多药类型(HR)、5种多耐药类型(以HE为主),复治患者表现为8种耐多药类型(以HRZ为主)、2种多耐药类型(以HS为主),复治患者耐多药率明显高于初治患者(P<0.05),但初、复治患者多耐药率经比较其差异无统计学意义(P>0.05);有无慢性病史、有无治疗中断对结核病患者耐药率的影响经比较其差异有统计学意义(均P<0.05)。结论:院内结核菌耐药情况仍十分严重,应加强抗结核药物的耐药性监测,并加强对结核病患者特别是复治患者的治疗管理,同时根据药敏结果选择科学有效的化疗方案。
Objective： To analyze the drug resistance of Mycobacterium tuberculosis and its influence factors and to provide a reference for better control and prevention strategy of drug resistant tuberculosis. Methods： Screening 115 cases of significantly positive results of the Mycobacterium tuberculosis culture and providing drug sensitivity test resuits in the hospital during January 2014 to December 2014. The clinical data were collected and was analyzed the drug resistance of five kinds of first class anti-tuberculosis drugs, including Mycobacterium tuberculosis to streptomycin （SM, S）, isoniazid （lNH, H）, rifampicin （RFP, R）, ethambutol （EMB, E）and pyrazinamide （PZA, Z）, and exploy- ing the influence factors of tuberculosis drug resistance. Results： 115 cases of Mycobacterium tuberculosis infection, 80 cases of newly diagnosed patients （69.57%） and 35 cases of retreatment patients （30.43%） were studied, initial treat- ment and retreatment patients resistant to any H rate, single drug resistance rate was the highest, retreatment patients of S, H, R, Z of any drug resistance rates were significantly higher than that of untreated patients （P〈0.05）; initial and re- treatment patients of single drug resistance rate showed no significant difference （P〉0.05）; initial treatment patients showed I type of multiple drug resistance （HR）, 5 multi drug resistant type （mainly HE）, retreatment patients showed 8 types （multiple drug resistance based on HRZ） and 2 kinds of multiple drug resistant type （mainly HS）, retreatment patients with multiple drug resistant rate was significantly higher than those of untreated patients （P〈0.05）, but the dif- ference of initial treatment and retreatment patients with multiple drug resistance rate was not statistically significant （P〉 0.05）; there was no history of chronic disease, had no effect on treatment interruption the differences in the rate of out patients with drug-resistant TB Had statistical significance （P〈0.05）. Conclusion： Nosocomial TB drug resistance is still very serious and should strengthen the monitoring of drug resistance of anti-tuberculosis drugs, strengthen TB pa- tients especially retreatment patient management, and optimize a scientific and effective chemotherapy based on the re- sults of drug sensitivity.
出处
《抗感染药学》
2016年第3期519-523,共5页
Anti-infection Pharmacy
关键词
结核分枝杆菌
耐药
影响因素
Mycobacterium tuberculosis
drug resistance
influence factor
