| PART ONE SPECIES IDENTIFICATION AND DRUGSUSCEPTIBILITY TEST OF218MYCOBACTERIUMSPECIESObjective：To investigate the species of Mycobacteria isolated fromchildren hospitalized in children’s hospital of Chongqing MedicalUniversity and their drug-resistant phenotypes to4commonly usedfirst-line anti-tuberculosis drugs, which gives insights into clinicaltreatment.Methods：Samples derived from children with TB during the studyperiod from February2008to December2013in our hospital were cultured,and culture-positive strains were subject to species identification as well asdrug susceptibility test of rifampicin, isoniazid, streptomycin, andethambutol.Results：Among the218Mycobacterium strains,199(91.5%) wereMycobacterium tuberculosis,17(7.8%) were Mycobacterium bovis, and2(0.9%) were non-tuberculosis mycobacterium strains. The total rates of drug resistance and multi-drug resistance were30.7%(67/218),6.4%(14/318) respectively. Drug resistance rates to SM, INH, EMB, RFP were21.6%(47/218),14.2%(31/218),11.5%(25/218),6.9%(15/218)respectively.Conclusions： There are drug-resistant TB cases in hospitalizedchildren with TB in our hospital, and a rising trend in recent years. PART TWO ANALYSIS OF RISK FACTORS ANDPROGNOSIS OF DRUG-RESISTANT TUBERCULOSIS INCHILDRENObjective：To study the risk factors and outcomes of drug-resistanttuberculosis in hospitalized children in our hospital.Methods：Drug susceptibility test was conducted in a total of198culture-confirmed Mycobacterium tuberculosis cases collected fromFebruary2008to December2013in the children’s Hospital of ChongqingMedical University. According to their drug-resistant phenotypes, allisolates were divided into drug-sensitive, drug-resistant, and multi-drugresistant group. Epidemiology and clinical data of each case were collected and we conducted a statistical analysis of the correlationbetween different drug-resistant phenotypes and demographic features aswell as clinical phenotypes using Chi-square test and Logistic regressionto explore the risk factors of drug-resistant and multi-drug resistant TBamong children in our hospital. Outcomes of each case were evaluated viaTelephone follow-up.Results：Among198cases,115were male, while83were female. Theage of cases ranged from25days to16.8years with an average of6.20±5.15years. The number of cases in urban and rural areas were71(35.9%)and127(64.1%) respectively. The number of BCG vaccinated cases were127(64.1%), while cases without BCG vaccination accounted for35.9%(71/198). Eighty-five (42.9%) cases had contact history while113(57.1%)didn’t. The duration of illness was≤1month in151（76.3%） cases and>1month in47（23.7%）cases. Disseminated tuberculosis were defined in80cases while the other118were non-disseminated tuberculosis. Smear forAcid fast bacilli was conducted in194samples, with88(45.4%) smearpositive while106(54.6%) smear negative. Above all, the positive ratio ofsmear between drug-sensitive and drug-resistant groups was significantdifferent (P=0.01, OR=0.338); The duration of illness before admission(P=0.026, OR=4.417) and the ratio of disseminated infection(P=0.012,OR=7.638) were found notable different between drug-sensitive andmulti-drug resistant group. The prognosis of108cases were available through telephone follow-up and a significant difference was distinguishedbetween drug-sensitive cases and drug-resistant cases to more than2drugs(P=0.000).Conclusions：The results of Acid fast bacilli of smear betweendrug-sensitive and drug-resistant groups were significant different. Theduration of illness before admission and disseminated infection are riskfactors of multi-drug resistant tuberculosis. Poor treatment outcomes wereexhibited in drug-resistant tuberculosis in children with high mortality. |
PDF Full Text Request