Mycobacterium tuberculosis multirezistences noteikšanas metodes

Abstract

Darba aktualitāte: Neskatoties uz to, ka šobrīd ir pieejami vairāki TB kontroles mehānismi gan slimības diagosticēšanai, gan ārstēšanai, un multirezistentās tuberkulozes prevalence samazinās, tā joprojām ir aktuāla problēma. Ņemot vērā, ka rezistence pret tuberkulozi dažādos reģionos krasi atškiras, svarīgi noskaidrot tās pašreizējo situāciju Latvijā un konkrētāk analizēt pret kuriem no anti-tuberkulozes medikamentiem reizistence ir sastopama visbiežāk. Darba mērķis: : Noteikt M. tuberculosis multirezistentu celmu prevalenci un salīdzināt fenotipiskās un genotipiskās multirezistences noteikšanas metodes. Metodes un materiāli: Diplomdarbā tika iekļauti dati par M. tuberculosis jutību pret dažādiem anti-tuberkulozes medikamentiem, kas iegūti izmantojot fenotipiskos zāļu jutības testus un genotipisko M.tuberculosis/Rifampicīna testu (GeneXpert). Iegūtie dati tika apstrādāti, izmantojot Microsoft Office Excel v16.4. Rezultāti un secinājumi: 1. Ar GeneXpert no 3666 veiktajiem testiem tuberkulozes izraisošo baktēriju klātbūtne tika konstatēta 356 jeb 9.71 % paraugos. 2. No 4089 ZJT pēc fenotipisko īpašību noteikšanas 849 jeb 20.76 % testos novērojama rezistence pret vismaz vienu no pirmās rindas, otrās rindas vai jaunās paaudzes medikamentiem. 3. Ar GeneXpert noteiktā rifampicīna rezistences prevalence ir 13.2% (n=356), savukārt ar fenotipiskajām metodēm noteiktā – 17.35% (n=634). 4. Visbiežāk rezistence sastopama pret otrās rindas medikamentu kapreomicīnu (37.75%) un pirmās rindas medikamentiem: izoniazīdu (34.55%) un pirazinamīdu (34.55%). Atslēgas vārdi: M. tuberculosis, GeneXpert, MDR-TB,

Overview: Despite multitude of means for the diagnosis and treatment of tuberculosis and the decreased prevalence of multidrug-resistant tuberculosis, the disease still persists. Given that tuberculosis resistance varies greatly from region to region, it is important to clarify its current situation in Latvia, and, more specifically, to analyze the strain prevalence and the treatment efficacy for some of the most common anti-tuberculosis drugs. Aim of the thesis: To determine the prevalence of M.tuberculosis multidrug-resistant strains and to compare phenotypic and genotypic multi-resistance detection methods. Methods and Materials: Data on the susceptibility of M.tuberculosis to various antituberculosis drugs was obtained by standardized phenotypic drug-sensitivity tests and a genotypic M.tuberculosis / Rifampicin (GeneXpert) analysis. The resulting data was tabulated and analyzed using Microsoft Office Excel v16.4. Results and Conclusions: 1. Representing 3666 separate GeneXpert samples, the presence of tuberculosis-causing bacteria was detected in 356 or 9.71% of samples. 2. By standardized 4089 ZJT phenotype drug-resistance detection, 849 or 20.76% of the tests were resistant to at least one of the first-line, second-line, or new-generation drugs. 3. The prevalence of rifampicin resistance determined by GeneXpert was 13.2% (n = 356), whereas that of phenotypic methods was 17.35% (n = 634), suggesting an underreporting by the GeneXpert system. 4. Resistance most commonly occurred with capreomycin (37.75%) and the first-line drugs: isoniazid (34.55%) and pyrazinamide (34.55%). Keywords: M. tuberculosis, GeneXpert, MDR-TB