Mycobacterium tuberculosis lineages and anti-tuberculosis drug resistance in reference hospitals across Viet Nam.
Mycobacterium tuberculosis lineages and anti-tuberculosis drug resistance in reference hospitals across Viet Nam.
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DOI：
10.1186/s12866-016-0784-6
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发表时间：
2016-07-28
期刊：
影响因子：
4.2
通讯作者：
Choisy M
中科院分区：
文献类型：
--
作者：
Nguyen VA;Bañuls AL;Tran TH;Pham KL;Nguyen TS;Nguyen HV;Nguyen NL;Nguyen NL;Dang DA;Marks GB;Choisy M
结核病 (TB) 病原体结核分枝杆菌尽管遗传多样性水平较低，但已揭示出与其谱系相关的多种生物学和流行病学特征，例如传播性、适应性和获得耐药性的倾向。这对结核病的流行病学具有重要意义。我们进行了首次全国性横断面研究，以确定流行的结核分枝杆菌谱系，并评估其流行病学关联及其与耐药性的关系。该研究是在越南各地参考医院获得的分离株中进行的。通过 spoligotyping 鉴定具有药物敏感性测试谱的分离株的谱系。使用逻辑回归研究结核分枝杆菌谱系与患者的位置、年龄和性别以及耐药水平的关联。结果显示，最常见的谱系是北京谱系（55.4%），其次是EAI谱系（27.5%）、T谱系（6.4%）、LAM谱系（1.3%）、哈勒姆谱系（1%）和零谱系（0.3%）。北京分离株在北部（70.4%）和南部（68%）的比例高于中心（28%）（OR = 1.7 [95%CI：1.4-2.0]，p< 0.0001），而北部（7.1%）和南部（17%）的EAI分离株比例则远低于中心。 (59%) (OR = 0.5 [95% CI: 0.4–0.6], p < 0.0001)。总体而言，北京分离株最有可能产生耐药性，而EAI分离株产生耐药性的可能性最小，但越南南部的EAI分离株也具有高度耐药性。年轻患者中北京分离株的比例显着较高（p< 0.01），而EAI分离株的比例显着较低（p< 0.05）。从男性患者和中年组患者中收集的分离株中，耐药比例较高。研究结果表明，在越南所有研究地区，EAI 谱系正在被高度耐药的北京谱系取代，该谱系主要对药物更敏感。工作年龄的男性患者应成为更好控制的重点，防止耐药结核病的出现。本文的在线版本 (doi:10.1186/s12866-016-0784-6) 包含补充材料，可供授权用户使用。
Mycobacterium tuberculosis, the tuberculosis (TB) pathogen, despite a low level of genetic diversity, has revealed a high variety of biological and epidemiological characteristics linked to their lineages, such as transmissibility, fitness and propensity to acquire drug resistance. This has important implications for the epidemiology of TB. We conducted this first countrywide cross-sectional study to identify the prevalent M. tuberculosis lineages and to assess their epidemiological associations and their relation to drug resistance. The study was conducted among isolates acquired in reference hospitals across Vietnam. Isolates with drug susceptibility testing profiles were identified for their lineages by spoligotyping. Logistic regression was used to investigate the association of M. tuberculosis lineages with location, age and sex of the patients and drug resistance levels. Results showed that the most prevalent lineage was Beijing (55.4 %), followed by EAI (27.5 %), T (6.4 %), LAM (1.3 %), Haarlem (1 %) and Zero type (0.3 %). The proportion of Beijing isolates in the North (70.4 %) and the South (68 %) was higher than in the Centre (28 %) (OR = 1.7 [95 % CI: 1.4–2.0], p < 0.0001), whereas the proportion of EAI isolates in the North (7.1 %) and the South (17 %) was much lower compared with the Centre (59 %) (OR = 0.5 [95 % CI: 0.4–0.6], p < 0.0001). Overall, Beijing isolates were the most likely to be drug-resistant and EAI isolates were the least likely to be drug-resistant, except in the South of Vietnam where EAI is also highly drug-resistant. The proportion of Beijing isolates was significantly higher (p < 0.01), and the proportion of EAI isolates was significantly lower (p < 0.05) in younger patients. The proportion of drug-resistance was higher in isolates collected from male patients and from patients in the middle age groups. The findings suggest ongoing replacement of EAI lineage, which is mainly more drug-susceptible with highly drug-resistant Beijing lineage in all studied regions of Vietnam. Male patients of working ages should be the focus for better control to prevent the emergence of drug-resistant TB. The online version of this article (doi:10.1186/s12866-016-0784-6) contains supplementary material, which is available to authorized users.