结核分枝杆菌耐药性的趋势和危险因素(M.结核病)在人类免疫缺陷病毒(HIV)感染的活动性结核病患者中进行了分析。收集2010年至2022年在上海市公共卫生临床中心接受治疗的结核分枝杆菌和HIV合并感染患者的临床资料。通过固体或液体培养证实了结核病的诊断。采用比例法进行表型药敏试验,并对一线和二线药物的耐药性进行分析。采用Logistic回归分析确定结核分枝杆菌耐药的相关危险因素。在304例结核分枝杆菌培养和一线药敏试验结果阳性的患者中,114(37.5%)对至少一种一线抗结核药物耐药。93例患者一线和二线药敏试验结果,40人(43%)对至少一种抗结核药物耐药,和20(21.5%),27(29.0%),19(20.4%),16(17.2%),14人(15.1%)对利福平有抗性,链霉素,氧氟沙星,左氧氟沙星,和莫西沙星,分别;17例患者(18.3%)患有耐多药结核病(MDR-TB).在2010年至2021年之间,对链霉素和利福平的耐药率为14.3%至40.0%和8.0%至26.3%,分别,呈逐年上升趋势。2016年至2021年,喹诺酮类药物耐药率在7.7%至27.8%之间波动,总体呈上升趋势。Logistic回归分析显示,年龄<60岁是链霉素耐药的危险因素,单药耐药,和任何耐药性(RR4.139,p=0.023;RR7.734,p=0.047;RR3.733,p=0.009)。复治结核病是利福平耐药的危险因素,氧氟沙星,左氧氟沙星(RR2.984,p=0.047;RR4.517,p=0.038;RR6.277,p=0.014)。HIV/AIDS患者结核分枝杆菌对利福平和喹诺酮类药物的耐药率较高,且呈逐年上升趋势。年龄和既往抗结核治疗史是HIV/AIDS合并结核病患者耐药发展的主要因素。
Trends in and risk factors for drug resistance in Mycobacterium tuberculosis (M. tuberculosis) in human immunodeficiency virus (HIV)-infected patients with active tuberculosis were analyzed. The clinical data of M. tuberculosis and HIV-coinfected patients treated at the Shanghai Public Health Clinical Center between 2010 and 2022 were collected. The diagnosis of tuberculosis was confirmed by solid or liquid culture. The phenotypic drug susceptibility test was carried out via the proportional method, and the resistance to first-line and second-line drugs was analyzed. Logistic regression analysis was performed to identify associated risk factors for drug resistance in M. tuberculosis. Of the 304 patients with a M. tuberculosis-positive culture and first-line drug susceptibility test results, 114 (37.5%) were resistant to at least one first-line anti-tuberculosis drug. Of the 93 patients with first-line and second-line drug susceptibility test results, 40 (43%) were resistant to at least one anti-tuberculosis drug, and 20 (21.5%), 27 (29.0%), 19 (20.4%), 16 (17.2%), and 14 (15.1%) were resistant to
rifampicin, streptomycin, ofloxacin, levofloxacin, and moxifloxacin, respectively; 17 patients (18.3%) had multidrug-resistant tuberculosis (MDR-TB). Between 2010 and 2021, the rate of resistance to streptomycin and
rifampicin ranged from 14.3% to 40.0% and from 8.0% to 26.3%, respectively, showing an increasing trend year by year. From 2016 to 2021, the rate of resistance to quinolones fluctuated between 7.7% and 27.8%, exhibiting an overall upward trend. Logistic regression analysis showed that being aged <60 years old was a risk factor for streptomycin resistance, mono-drug resistance, and any-drug resistance (RR 4.139, p = 0.023; RR 7.734, p = 0.047; RR 3.733, p = 0.009). Retreatment tuberculosis was a risk factor for resistance to
rifampicin, ofloxacin, of levofloxacin (RR 2.984, p = 0.047; RR 4.517, p = 0.038; RR 6.277, p = 0.014). The drug resistance rates of M. tuberculosis to
rifampicin and to quinolones in HIV/AIDS patients were high and have been increasing year by year. Age and a history of previous anti-tuberculosis treatment were the main factors associated with the development of drug resistance in HIV/AIDS patients with tuberculosis.