上海市非结核分枝杆菌感染趋势及耐药分析

Susceptibility Pattern and Epidemiology of Nontuberculous Mycobacteria in Shanghai

目的分析上海市近7年来非结核分枝杆菌(NTM)的感染趋势、分布及耐药情况。方法对1998-2004年间医院确定为NTM的菌种用传统的生化反应法进行菌种鉴定,及以罗氏培养基为基础的绝对浓度法中的间接法做NTM的药物敏感试验。结果从1998-2004年NTM感染占分枝杆菌属培养阳性率分别为1.49%、1.17%、1.98%、2.46%、2.66%、2.72%、3.00%,基本呈上升趋势;感染菌种的分布Ⅰ群为18.7%、Ⅱ群5.1%、Ⅲ群25.1%、Ⅳ群51.1%;大多数NTM对常用的抗结核药物呈高度耐药,特别是Ⅳ群中的龟分枝杆菌和偶发分枝杆菌出现多重耐药现象。结论上海市NTM感染呈逐年上升趋势;感染菌种的分布以Ⅳ群快速生长的NTM为主;NTM对常用的抗结核药物呈高度耐药现象。

OBJECTIVE To examine the prevalence and trends of drug resistance of nontubereulous myeobaeteria （NTM）in Shanghai. METHODS All NTM strains isolated between 1998 and 2004 in Shanghai were identified with conventional biochemical tests. Antimierobial susceptibility test for all NTM was performed by standard absolute concentration method. RESULTS The prevalence rate was determined as 1. 49%, 1. 17%, 1. 98%, 2. 46%, 2.66%, 2.72% and 3.0% among myeobaeteria culture positive patients per year in 1998, 1999, 2000, 2001, 2002, 2003, and in 2004, respectively. These data indicated the prevalence rate has continuously increased. Distribution of NTM isolates was Group Ⅰ 18.7%, Group Ⅱ 5.1%, Group Ⅲ 25.1%, and Group Ⅳ 51.1% accordingly. Group Ⅳ rapidly growing NTM accounted for maiority of them. Most of NTM showed high drug resistance to general antitubereulotie drug. In particular Group IV Mycobacterium chelonae and M. fortuitum appeared multi-drug resistance. CONCLUSIONS The prevalence rate of NTM in Shanghai shows increased tendency. Most of NTM isolates are Group IV rapidly growing NTM. NTM shows high drug resistance to first line antituberculotie substance.