薬剤耐性菌感染症の現状と検査室の対応(1)

結核菌感染症

鈴　木　克　洋*1　富　田　元　久*2　木　下　幸　保*3
吉　田　　　亮*4　吉　田　志緒美*5　露　口　一　成*6
入　江　章　子*7　山　本　　　暁*8　坂　谷　光　則*9
　　　　　　　　　　　　　　　　　　　　　　
Present Trends of Drug-resistant Tuberculosis and How to Manage It
by Mycobacterial Laboratories

Katsuhiro SUZUKI, MD*1, Motohisa TOMITA*2, Yukiyasu KINOSHITA*3, Akira YOSHIDA, MD*4
Shiomi YOSHIDA*5, Kazunari TSUYUGUCHI, MD*6, Akiko IRIE*7
Akira YAMAMOTO, MD*8 and Mitsunori SAKATANI, MD*9

Global, domestic, and local trends of drug-resistant tuberculosis and how to manage increase in the resistance by mycobacterial laboratories were discussed based on literatures and our own data. At first, how to make drug-resistant tuberculosis was explained. Genetic drug-resistant bacteria were emerged spontaneously by mutation of the genome and were selected by inadequate treatment(mono-therapy or functional mono-therapy): acquired drug resistance(single, and then multi-drug resistance). In a mean time, some people were infected with the drug-resistant bacteria from the beginning and a part of them developed active disease: primary drug resistance(single or multi-drug resistance). Estonia, Latvia, Iran, and some part of Russia, China, and India were reported to be the most endemic region of drug resistant and multi-drug resistant tuberculosis in the world. The rate of primary resistance in Japan was as high as the median of the world, but the rate of acquired resistance was almost twice of the median. Since delays in reporting of the drug resistance from the laboratory seemed one of reasons for the inadequate treatment, drug susceptibility testing should be more rapid than usual, by using liquid media such as BACTEC MGIT 960^TM system, or gene analysis.
[Rinsho Byori 50 : 847〜852, 2002]

*1Clinical Research Center, National Kinki-Chuo Hospital for Chest Diseases, Sakai 591-8025

【Key Words】M. tuberculosis(結核菌)，drug resistance(薬剤耐性)，drug susceptibility test(薬剤感受性試験)

*1,5,6国立療養所近畿中央病院臨床研究センター，*2,3,7,8研究・検査科，*4,9内科(〒591-8025 堺市長曽根町1180)