Drug Resistance And Rifampin Resistant Genes In Tuberculosis Patients In Southern Fujian

Objectives To investigate the drug resistance and epidemiological characteristics of tuberculosis patients in southern Fujian,to provide evidence for the rationalization and standardization of tuberculosis treatment,and to study the mutation of rifampicin resistance gene in tuberculosis patients in southern Fujian。 Methods(1)928 positive sputum smears were collected from TB patients in the Department of tuberculosis control,respiratory department and tuberculosis clinic of a city’s CDC in southern Fujian from January 2016 to December 2018.860 positive sputum specimens were cultured on the traditional modified Roche medium,and 77 clinical isolates of single tuberculosis were isolated and purified.(2)860 sputum culture positive specimens were tested with first-line anti-tuberculosis drugs streptomycin,isoniazid,rifampicin and ethambutol by traditional proportional drug sensitivity test.The total drug resistance rate of anti-tuberculosis drugs in this area was analyzed.The drug resistance rate was divided into five groups according to gender,age,occupation,history of anti-tuberculosis treatment and residence.19.0 software(Statistical Package for the Social Science)was used for data analysis and 2 test,and P < 0.05 was taken as statistical significant difference.(3)Polymerase chain reaction(PCR)was used to sequence 77 clinical isolates of single tuberculosis,and to study the mutation of rifampicin resistance gene and drug resistance analysis.(4)A real-time fluorescence quantitative nucleic acid amplification assay(Xpert MTB/RIF)for rifampicin resistance was used to detect 77 isolated clinical isolates of tuberculosis and analyze the mutation of rifampicin resistance genes.Results(1)860 sputum smear positive specimens were cultured,and the positive rate was 92.67%(860/928);(2)860 sputum smear positive specimens were resistant to four first-line anti-tuberculosis drugs from high to low in order: streptomycin,isoniazid,rifampicin,ethambutol,269 cases were resistant to one or more anti-tuberculosis drugs,the total resistance rate was 31.28%(269/860);the prevalence of tuberculosis in males was higher than that in females;the drug resistance rate of tuberculosis in males was higher than that in females;there was no significant difference in the multidrug resistance rate of tuberculosis between the two groups;the prevalence rate,drug resistance rate and multidrug resistance rate of tuberculosis patients aged 30-60 years were significantly higher than those of tuberculosis patients aged less than 30 years and older than 60 years.The tuberculosis resistance rate and multi-drug resistance rate of tuberculosis bacteria were higher in farmers than in workers and peasants,and the tuberculosis resistance rate and multidrug resistance rate of tuberculosis bacteria in retreated tuberculosis patients were higher than those in newly diagnosed tuberculosis patients.The chi-square test showed that the tuberculosis rate in rural areas was higher than that in urban areas(P < 0.05).There was no significant difference in the incidence of nuclear disease,drug resistance rate and multidrug resistance rate between the two groups(P > 0.05);(3)Seventy-seven clinical isolates of tuberculosis were cultured by traditional drug sensitivity method,and 62 clinical isolates of tuberculosis were resistant to rifampicin,rifampicin resistance was often combined with isoniazid resistance,and 57 clinical isolates of single tuberculosis were detected rpoB gene mutation by DNA sequencing.rpoB 531 locus was the most common single nucleotide polymorphism(SNP);(4)77 clinical isolates of single tuberculosis were resistant to rifampicin by Xpert.The results of Xpert MTB/RIF were all Mycobacterium tuberculosis and 57 strains of Mycobacterium tuberculosis were resistant to rifampicin,which was consistent with the results of DNA sequencing.Conclusion(1)The drug resistance rate of tuberculosis patients to firstline anti-tuberculosis drugs is not low in southern Fujian,and the drug resistance situation of Mycobacterium tuberculosis is not optimistic;(2)The prevention and control of tuberculosis in southern Fujian still needs to focus on rural areas,pay attention to health education for workers and farmers,and pay attention to the high drug resistance rate and multi-drug resistance rate of tuberculosis in young and middle-aged male tuberculosis patients.(3)Mycobacterium tuberculosis is often resistant to rifampicin and isoniazid at the same time.The resistance of Mycobacterium tuberculosis to rifampicin is related to rpoB gene.The most common mutation point is 531 locus.The results of DNA sequencing are consistent with those of Xpert MTB/RIF method.Some phenotypes of rifampicin resistance of Mycobacterium tuberculosis are inconsistent with genotypes,and other undetected mutations may exist.Situation.