First-line drug resistance characteristics of Mycobacterium tuberculosis isolates from patients with human immunodeficiency virus/Mycobacterium tuberculosis coinfection

doi:10.3877/cma.j.issn.1674-1358.2018.05.004

Abstract

Abstract:

Objective

To investigate the drug resistance characteristics ofMycobacterium tuberculosis (MTB) isolates to four first-line antituberculous drugs from patients with human immunodeficiency virus (HIV)/MTB coinfection, and to guide the clinical treatment.

Methods

MTB strains were isolated from 154 cases with HIV/MTB coinfection (experimental group) and 357 cases with HIV-negative tuberculosis (control group) who were admitted to Shanghai Public Health Clinical Center between January 2012 and December 2016. The drug resistance patterns to isoniazide (INH), rifampicin (RFP), ethambutol (EMB) and streptomycin (STR) were analyzed. The total drug resistance, multi-drug resistance, initial resistance and acquired drug resistance were compared, respectively.

Results

Among the 154 MTB isolates from tuberculosis patients with HIV infection, the rate of total resistance (44.2%, 68/154), initial resistance (42.2%, 19/45) initial multidrug-resistance (13.3%, 6/45), STR total resistance (31.8%, 49/154) and STR initial drug resistance (28.9%, 13/45) were significantly higher than those of TB patients without HIV infection (33.9%, 25.0%, 3.8%, 22.7%, 11.4%, respectively; allP < 0.05). While the resistance to INH, RFP, EMB showed no statistically significant difference between the two groups (allP> 0.05). Among patients with TB without HIV infection, the rate of acquired drug resistance (39.1%, 88/225) and acquired multidrug-resistance (19.1%, 43/225) were significantly higher than initial resistance (25.0%, 33/132) and initial multidrug-resistance (3.8%, 5/132) (χ²= 16.785,P< 0.001;χ²= 7.393,P= 0.004).

Conclusions

The situation of drug resistance and multidrug resistance in HIV/MTB coinfected patients was serious, especially STR, which indicated that clinicians should pay attention to MTB drug resistance in HIV infected patients and take timely preventive measures as well as individual treatment.

Key words: Human immunodeficiency virus, Mycobacterium tuberculosis, Coinfection, Drug resistance characterization

Qian Guo, Zhaoqin Zhu, Xueqin Qian, Xin Jin, Jun Su, Tengfei Zhang, Jianhao Wei. First-line drug resistance characteristics of Mycobacterium tuberculosis isolates from patients with human immunodeficiency virus/Mycobacterium tuberculosis coinfection[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2018, 12(05): 434-439.

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References 22

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基本资料		HIV/MTB双重感染组(154例)	单纯结核病组(357例)	统计值	P值
性别[例(%)]		?	?	χ² = 1.655	0.121
?	男	130(84.4)	284(79.6)	?	?
?	女	24(15.6)	73(20.4)	?	?
年龄(±s，岁)		39.50 ± 12.90	42.22 ± 22.45	t = 1.710	0.088
治疗史[例(%)]		?	?	χ² = 2.857	0.055
?	初治	45(29.2)	132(37.0)	?	?
?	复治	109(70.8)	225(63.0)	?	?
标本类型[例(%)]		?	?	?	?
?	痰液	93(60.4)	219(61.3)	χ² = 0.041	0.457
?	血液	12(7.8)	6(1.7)	χ² = 11.825	0.001
?	脑脊液	11(7.1)	5(1.4)	χ² = 11.697	0.001
?	胸腹水	7(4.5)	21(5.9)	χ² = 0.371	0.354
?	穿刺液	7(4.5)	29(8.1)	χ² = 2.103	0.101
?	分泌物	6(3.9)	32(9.0)	χ² = 4.014	0.030
?	其他	18(11.7)	45(12.6)	χ² = 0.084	0.449
DST结果[例(%)]		?	?	χ² = 4.862	0.018
?	全敏感	86(55.8)	236(66.1)	?	?
?	耐药	68(44.2)	121(33.9)	?	?
MDR-TB [例(%)]		29(18.8)	48(13.4)	χ² = 2.439	0.078

基本资料		HIV/MTB双重感染组(154例)	单纯结核病组(357例)	统计值	P值
性别[例(%)]		?	?	χ² = 1.655	0.121
?	男	130(84.4)	284(79.6)	?	?
?	女	24(15.6)	73(20.4)	?	?
年龄(±s，岁)		39.50 ± 12.90	42.22 ± 22.45	t = 1.710	0.088
治疗史[例(%)]		?	?	χ² = 2.857	0.055
?	初治	45(29.2)	132(37.0)	?	?
?	复治	109(70.8)	225(63.0)	?	?
标本类型[例(%)]		?	?	?	?
?	痰液	93(60.4)	219(61.3)	χ² = 0.041	0.457
?	血液	12(7.8)	6(1.7)	χ² = 11.825	0.001
?	脑脊液	11(7.1)	5(1.4)	χ² = 11.697	0.001
?	胸腹水	7(4.5)	21(5.9)	χ² = 0.371	0.354
?	穿刺液	7(4.5)	29(8.1)	χ² = 2.103	0.101
?	分泌物	6(3.9)	32(9.0)	χ² = 4.014	0.030
?	其他	18(11.7)	45(12.6)	χ² = 0.084	0.449
DST结果[例(%)]		?	?	χ² = 4.862	0.018
?	全敏感	86(55.8)	236(66.1)	?	?
?	耐药	68(44.2)	121(33.9)	?	?
MDR-TB [例(%)]		29(18.8)	48(13.4)	χ² = 2.439	0.078

耐药		HIV/MTB双重感染组(154例)	单纯结核分枝杆菌感染病组(357例)	χ²值	P值
全敏感		86(55.8)	236(66.1)	4.862	0.018
耐药		68(44.2)	121(33.9)	?	?
?	MDR-TB	29/154(18.8)	48/357(13.4)	2.439	0.078
?	初始耐药	19/45(42.2)	33/132(25.0)	4.798	0.024
?	初始MDR-TB	6/45(13.3)	5/132(3.8)	5.246	0.032
?	获得性耐药	49/109(45.0)	88/225(39.1)	1.036	0.184
?	获得性MDR-TB	23/109(21.1)	43/225(19.1)	0.183	0.386

耐药		HIV/MTB双重感染组(154例)	单纯结核分枝杆菌感染病组(357例)	χ²值	P值
全敏感		86(55.8)	236(66.1)	4.862	0.018
耐药		68(44.2)	121(33.9)	?	?
?	MDR-TB	29/154(18.8)	48/357(13.4)	2.439	0.078
?	初始耐药	19/45(42.2)	33/132(25.0)	4.798	0.024
?	初始MDR-TB	6/45(13.3)	5/132(3.8)	5.246	0.032
?	获得性耐药	49/109(45.0)	88/225(39.1)	1.036	0.184
?	获得性MDR-TB	23/109(21.1)	43/225(19.1)	0.183	0.386

耐药		HIV/MTB双重感染组			单纯结核分枝杆菌感染组
耐药		初治(45例)	复治(109例)	合计(154例)	初治(132例)	复治(225例)	合计(357例)
任何耐药		?	?	?	?	?	?
?	INH	9(20.0)	36(33.0)	45(29.2)	21(15.9)	72(32.0)	93(26.1)
?	RFP	9(20.0)	29(26.6)	38(24.7)	11(8.3)	51(22.7)	62(17.4)
?	EMB	4(8.9)	21(19.3)	25(16.2)	6(4.5)	33(14.7)	39(10.9)
?	STR	13(28.9)	36(33.0)	49(31.8)	15(11.4)	66(29.3)	81(22.7)
单药耐药		?	?	?	?	?	?
?	INH	2(4.4)	4(3.7)	6(3.9)	11(8.3)	6(2.7)	17(4.8)
?	RFP	3(6.7)	4(3.7)	7(4.5)	4(3.0)	6(2.7)	10(2.8)
?	STR	7(15.6)	5(4.6)	12(7.8)	6(4.5)	8(3.6)	14(3.9)
2种药物耐药		?	?	?	?	?	?
?	INH + RFP	1(2.2)	3(2.8)	4(2.6)	0(0.0)	4(1.8)	4(1.1)
?	RFP + STR	0(0.0)	2(1.8)	2(1.3)	2(1.5)	2(0.9)	4(1.1)
?	INH + EMB	0(0.0)	1(0.9)	1(0.6)	1(0.8)	2(0.9)	3(0.8)
?	INH + STR	1(2.2)	6(5.5)	7(4.5)	4(3.0)	18(8.0)	22(6.2)
?	EMB + STR	0(0.0)	2(1.8)	2(1.3)	0(0.0)	0(0.0)	0(0.0)
3种药物耐药		?	?	?	?	?	?
?	INH + RFP + EMB	0(0.0)	1(0.9)	1(0.6)	2(1.5)	4(1.8)	6(1.7)
?	INH + RFP + STR	1(2.2)	4(3.7)	5(3.2)	0(0.0)	11(4.9)	11(3.1)
?	INH + EMB + STR	0(0.0)	2(1.8)	2(1.3)	0(0.0)	3(1.3)	3(0.8)
4种药物耐药		?	?	?	?	?	?
?	INH + RFP + EMB + STR	4(8.9)	15(13.8)	19(12.3)	3(2.3)	24(10.7)	27(7.6)
合计		19(42.2)	49(45.0)	68(44.2)	33(25.0)	88(39.1)	121(33.9)

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