为探讨艾滋病患者临床标本分枝杆菌培养阳性率、菌种类型及耐药状况,本研究对2010年1月—2019年12月在广西某医院就诊的艾滋病患者的临床标本进行分枝杆菌培养,分离鉴定后用8种以上抗结核药物进行药敏试验。结果显示,艾滋病患者临床标本分枝杆菌培养总阳性率为15.68%(2 163/13 795),脓液、分泌物、组织标本、胸腹水等标本阳性率高。经初步菌种鉴定,结核分枝杆菌复合群占77.95%(1 442/1 850),非结核分枝杆菌占22.05%(408/1 850),后者10年中占比15.71%~26.07%,年间差异无统计学意义(χ2=10.442,P>0.05)。结核分枝杆菌的总耐药率为23.30%(336/1 442),年间差异有统计学意义(χ2=18.901,P=0.026),其对异烟肼的耐药率为12.14%(175/1 442)、对利福平为10.54%(152/1 442)、对链霉素为9.29%(134/1 442)、对氧氟沙星为5.62%(81/1 442)、对乙胺丁醇为3.05%(44/1 442)、对对氨基水杨酸为1.80%(26/1 442)、对卡那霉素为1.32%(19/1 442),耐多药率、广泛耐药率分别为5.48%(79/1 442)、0.28%(4/1 442)。研究表明,艾滋病患者临床标本分枝杆菌培养阳性率高,其中非结核分枝杆菌占 15.71%~26.07%,10年来基本稳定。结核分枝杆菌对异烟肼耐药率最高,利福平次之。因此,应该对艾滋病患者临床标本进行分枝杆菌培养、鉴定和耐药性检测,从而为临床诊治提供可靠依据。
蒙志好1
,
韦永忠1
,
廖光付1
,
吕康言1
,
陆雪萍1
,
左勇1
,
蓝珂1
,
唐月璐1
,
沈银忠2
. 广西地区艾滋病患者临床标本分枝杆菌培养及耐药性分析[J]. 微生物与感染, 2021
, 16(2)
: 103
-109
.
DOI: 10.3969/j.issn.1673-6184.2021.02.005
To investigate the positive rate, species and drug resistance of Mycobacteria in clinical specimens of acquired immunodeficiency syndrome (AIDS) patients, the AIDS patients in a hospital in Guangxi during January 2010 and December 2019 were collected and their clinical specimens were cultured with acid-fast bacilli. The antimicrobial susceptibility testing was conducted with more than eight anti-tuberculosis drugs after isolation and identification. The overall positive rate was 15.68% (2 163/13 795). The positive rate was high in pus, secretions, various tissue specimens, pleural effusion, and ascites. The species identification results showed that Mycobacteria tuberculosis compound group accounted for 77.95% (1 442/1 850) and non-tuberculosis Mycobacterium (NTM) accounted for 22.05% (408/1 850). The latter accounted for 15.71%-26.07% over 10 years, with no statistically significant difference between years (χ2=10.442, P>0.05). The overall drug resistance rate was 23.30% (336/1 442), with a significant difference over a 10-year period (χ2=18.901, P=0.026). The rates of resistance to isoniazid, rifampicin, streptomycin, ofloxacin, ethambutol, p-amino salicylic acid, kanamycin were 12.14% (175/1 442), 10.54% (152/336), 9.29% (134/1 442), 5.62% (81/1 442), 3.05% (44/1 442), 1.80% (26/1 442), 1.32% (19/1 442), respectively. The prevalence of multidrug-resistant tuberculosis (DR-TB) and extensively drug-resistant tuberculosis (XDR-TB) was 5.48% (79/1 442) and 0.28% (4/1 442), respectively. It is confirmed that the positive rate of Mycobacteria isolated from the clinical specimens of AIDS patients is high and NTM accounts for a high proportion. The drug resistance rate of Mycobacterium tuberculosis to commonly used anti-tuberculosis drugs is high. It is suggested that clinical Mycobacterium identification and antimicrobial susceptibility testing should be carried out to provide a reliable basis for clinical diagnosis and treatment.