Study On The Relationship Between Drug Resistance Of Mycobacterium Tuberculosis And Its Epidemic And Dynamic Changes In Part Of Henan Province

Objective(1)To understand the epidemic characteristics and trend of Mycobacterium tuberculosis in Henan Province during the three years of 2015-2017;(2)To preliminarily clarify the status quo of drug resistance of Mycobacterium tuberculosis in this area;(3)To analyze the influencing factors of drug resistance and multidrug resistance,so as to provide reference for the effective control of tuberculosis,especially for the formulation of the scientific control strategy of multidrug resistant tuberculosis.Methods The clinical isolates,background data and standard strain H37 Rv from 2015 to 2017 were collected.The improved Roche medium was used for routine culture and collection of bacteria.The protein was extracted and identified by matrix assisted time of flight mass spectrometry(MALDI-TOF-MS).The drug sensitivity test was carried out for the Mycobacterium tuberculosis complex group,MIC),analysis of 12 first-line and second-line antituberculous drugs of Mycobacterium tuberculosis,including ofloxacin(OFL),moxifloxacin(MXF),rifampin(RIF),amikacin(AMI),streptomycin(STR),rifabutin(RFB),p-aminosalicylic acid(PAS),ethionine(ETH),cycloserine(CYC),isoniazid(INH),kanamycin(Kan),ethambutol(Resistance to EMB).The method of MIRU-VNTR was used for genotyping,and cluster analysis was used for the results.Results(1)375clinical isolates were included in this study,the total drug resistance rate was 25.6%(96 / 375),21.58%(71 / 329)in the first treatment and 54.34%(25 / 46)in the second treatment,The multidrug resistance rate was 4.53%(17 / 375);(2)INH(16.26%)> str(14.66%)> CYC(7.46%)> MXF(5.33%)> RIF(5.06%)> ofl(4.8%)> RFB(4.5%)> pas(2.66%)> eth(2.66%)> Kan(2.4%)> EMB(2.4%)> AMK(1.6%);(3)The trend chi square test showed that there was significant difference in the drug resistance rate except streptomycin and cycloserine(STR: 2 trend = 4.797,P = 0.029;CYC: 2 trend = 11.53,P = 0.001),there was no significant difference in the changes of other antituberculosis drugs(P > 0.05);(4)Single factor and multi factor analysis of drug-resistant tuberculosis showed that drug resistance was significantly related to the treatment history of patients(AOR = 24.744),The single factor and multi factor analysis of MDR-TB showed that there was a significant correlation between MDR and treatment history(AOR = 4.243,P = 0.013).Drug resistance and multidrug resistance were not related to age,address,gender and Education(P > 0.05).(5)By cluster analysis,375 strains of Mycobacterium tuberculosis were divided into 3 gene groups,248 genotypes,237 of which were unique,2 of 6 genotypes,3 of 4 genotypes,4 of 1 genotype,the clustering rate was 7.5%(28 / 375).Conclusion(1)From 2015 to 2017,the drug resistance trend of tuberculosis in some areas of Henan Province is generally stable.Retreatment is an independent risk factor for drug resistance and multidrug resistance;(2)In some areas of Henan Province,the drug resistance rate to cycloserine is high,and the drug resistance rate shows an increasing trend,warning that standardized use should be strengthened;(3)In some areas of Henan Province,the distribution of Mycobacterium tuberculosis genotypes is polymorphic,and the clustering rate is not high,indicating that there is a short-term transmission but the transmission is not obvious,suggesting that it may be possible It is caused by endogenous resurgence.