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背景:德国1995年至2001年。目的:确定在德国分离出的451株耐多药结核分枝杆菌株间的基因相关性,以及鉴定北京基因型菌株。设计:所有菌株均行IS6110指纹及簇型分析。成簇的分离菌株作为近期传播的尺度。结果:433株中有214株(49.4%)具有4个以上IS6110拷贝,构成了46个指纹簇型,包含2-32例病人。以经典的流行病学资料为基础,39例病人(18.2%)、在14个簇型(30.4%)间建立了传播联系,还包括3例MDR-TB(耐多药结核杆菌)的外源性再感染。有175株(38.8%)为北京基因型菌株,并呈逐年增长趋势,从1995年的19.2%增至2001年的58.3%。这些病例约70%在国外主要是前苏联出生。结论:MDR-TB菌株的传播看来是导致德国MDR-TB播散的原因。MDR-TB菌株的外源性再感染应考虑为治疗失败的可能原因。高比例的MDR-TB菌株很可能是由前苏联传入,北京基因型菌株说明了MDR-TB在德国增长的原因之一。
Background: Germany, 1995-2001. OBJECTIVE: To determine the genetic relationship among 451 multidrug-resistant M. tuberculosis isolates isolated in Germany and to identify Beijing genotype strains. Design: All strains were performed IS6110 fingerprinting and cluster analysis. Clustered isolates serve as a measure of recent spread. RESULTS: Of the 433 strains, 214 (49.4%) had more than 4 copies of IS6110, constituting 46 fingerprinted clusters containing 2-32 patients. Based on the classic epidemiological data, 39 patients (18.2%) developed a transmission link between 14 clusters (30.4%) and also included 3 cases of exogenous Infective again. A total of 175 (38.8%) isolates belonged to genotypes of Beijing, increasing year by year from 19.2% in 1995 to 58.3% in 2001. About 70% of these cases are mainly from abroad in the former Soviet Union. Conclusion: The spread of MDR-TB strains appears to be responsible for the spread of MDR-TB in Germany. Exogenous reinfection of MDR-TB strains should be considered as a possible cause of treatment failure. A high proportion of MDR-TB strains is likely to be introduced from the former Soviet Union, and Beijing genotype strains illustrate one of the reasons why MDR-TB has increased in Germany.