Study of fluoroquinolones resistance in rifampicin-resistant tuberculosis patients in Beijing: Characteristics, trends, and treatment outcomes

Q1 Health Professions
Wang Nenhan, Tian Lili, Zhao Yanfeng, Chen Shuangshuang, Tao LiYing, Li Qiao, Li Chuanyou, Dai Xiaowei
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引用次数: 0

Abstract

Background

China is a high-burden country for multidrug-resistant tuberculosis/rifampin-resistant tuberculosis (MDR/RR-TB). Fluoroquinolones (FQs) are key drugs for the treatment of patients with MDR/RR-TB. However, research on the resistance of FQs in Beijing is limited.

Methods

We collected clinical isolates from all patients with pulmonary TB in Beijing from January 2016 to December 2021, conducted drug-sensitivity tests and sequencing for levofloxacin (LFX) and moxifloxacin (MFX), and collected the treatment plans and outcomes of the patients.

Results

A total of 8512 clinical isolates were collected from patients with pulmonary TB, and 261 RR-TB strains were screened. The proportions of drug-sensitive and drug-resistant strains significantly differed by age group and treatment history. The rates of LFX and MFX resistance were 27.6% (72/261) and 36.4% (95/261), respectively. The detection rates of MDR-TB and pre-extensively drug-resistant TB (pre-XDR-TB) were 73.2% (191/261) and 36.4% (95/261), respectively, and the trends were significant (χ2 trend = 9.995, p = 0.002; χ2 trend = 12.744, p = 0.026). Among the 261 RR-TB strains, 14.9% (24/261) were sensitive to LFX but resistant to MFX. Among the four patients with LFX-resistant TB who received LFX treatment failed in three patients(Fisher's exact test, p = 0.009). The common mutation sites were 94 and 90 in gyrA. A novel mutation Ala90Ser was discovered.

Conclusions

FQs resistance trends in RR-TB patients in Beijing are striking. Strains showed incomplete cross-resistance to LFX and MFX. Testing for FQs resistance and developing a reasonable treatment plan are recommended. Attention should be given to the changing trends in MDR-TB and pre-XDR-TB.

Abstract Image

北京地区利福平耐药结核病患者氟喹诺酮类药物耐药性研究:特点、趋势及治疗结果
背景:中国是耐多药结核病/利福平耐药结核病(MDR/RR-TB)的高负担国家。氟喹诺酮类药物是治疗MDR/RR-TB患者的关键药物。但对北京地区FQs的抗性研究较少。方法:收集2016年1月至2021年12月北京地区所有肺结核患者的临床分离株,对左氧氟沙星(LFX)和莫西沙星(MFX)进行药敏试验和测序,收集患者的治疗方案和结局。结果:从肺结核患者中共收集到8512株临床分离株,筛选出261株RR-TB菌株。耐药菌株和药敏菌株的比例因年龄组和治疗史的不同而有显著差异。LFX和MFX的耐药率分别为27.6%(72/261)和36.4%(95/261)。耐多药结核病和广泛耐药前结核病(pre-XDR-TB)检出率分别为73.2%(191/261)和36.4%(95/261),趋势具有统计学意义(χ2趋势= 9.995,p = 0.002;χ2趋势= 12.744,p = 0.026)。261株RR-TB菌株中,14.9%(24/261)对LFX敏感,对MFX耐药。在接受LFX治疗的4例耐药结核病患者中,有3例患者失败(Fisher精确检验,p = 0.009)。gyrA的常见突变位点为94和90。一种新的突变Ala90Ser被发现。结论:北京地区RR-TB患者FQs耐药趋势显著。菌株对LFX和MFX表现不完全交叉抗性。建议进行FQs耐药检测并制定合理的治疗方案。应注意耐多药结核病和前广泛耐药结核病的变化趋势。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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CiteScore
5.50
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