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

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。

Isolation and drug resistance of Mycobacterium from clinical specimens of acquired immunodeficiency syndrome patients in Guangxi

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.