339株非结核分枝杆菌临床分离株菌种鉴定及耐药性分析

Spectrum and drug resistance analysis of 339 strains of nontuberculous mycobacterium isolated from clinical practice

回顾性分析2014年3月至2019年3月天津市海河医院经罗氏培养和"DNA微阵列芯片技术"确定的339株非结核分枝杆菌(NTM),并对其药物敏感性试验(简称"药敏试验")结果进行分析。339株NTM临床分离株中,排在前3位者分别为胞内分枝杆菌38.6%(131/339)、龟-脓肿分枝杆菌21.2%(72/339)、堪萨斯分枝杆菌18.3%(62/339)。体外药敏试验显示胞内分枝杆菌、堪萨斯分枝杆菌和龟-脓肿分枝杆菌对8种抗结核药品(异烟肼、利福平、链霉素、乙胺丁醇、对氨基水杨酸、卡那霉素、卷曲霉素、氧氟沙星)耐药率情况为:胞内分枝杆菌的耐药率分别为95.6%(108/113)、82.3%(93/113)、94.7%(107/113)、54.0%(61/113)、92.0%(69/75)、81.3%(61/75)、85.3%(64/75)、87.5%(49/56);堪萨斯分枝杆菌的耐药率分别为100.0%(54/54)、3.7%(2/54)、98.1%(53/54)、11.1%(6/54)、95.0%(38/40)、90.0%(36/40)、27.5%(11/40)、13.8%(4/29);龟-脓肿分枝杆菌的耐药率分别为96.9%(62/64)、93.8%(60/64)、95.3%(61/64)、92.2%(59/64)、88.4%(38/43)、86.0%(37/43)、88.4%(38/43)、87.1%(27/31)。临床分离NTM菌种以胞内分枝杆菌、龟-脓肿分枝杆菌、堪萨斯分枝杆菌为主,其中胞内分枝杆菌、龟-脓肿分枝杆菌对常用一线、二线抗结核药品具有较高的耐药性,堪萨斯分枝杆菌对利福平、乙胺丁醇、氧氟沙星、卷曲霉素的耐药率低。

From March 2014 to March 2019,339 strains were identified as nontuberculous mycobacterium(NTM)by Roche culture and DNA microarray technology in Tianjin Haihe Hospital.Drug sensitivity test(DST)were performed.Among 339 NTM clinical isolates,the top three were M.intracellulare(38.6%,131/339),M.cheloni-abscessus(21.2%,72/339)and M.kansas(18.3%,62/339).In vitro DST showed that the drug resistance rates of M.intracellular,M.Kansas an M.cheloni-abscessus to 8 antituberculosis drugs(isoniazid,rifampin,streptomycin,ethambutol,p-aminosalicylic acid,kanamycin,capreomycin,ofloxacin)were:95.6%(108/113),82.3%(93/113),94.7%(107/113),54.0%(61/113),92.0%(69/75),81.3%(61/75),85.3%(64/75),87.5%(49/56)for M.intracellulare;100.0%(54/54),3.7%(2/54),98.1%(53/54),11.1%(6/54),95.0%(38/40),90.0%(36/40),27.5%(11/40),13.8%(4/29)for M.kansas;96.9%(62./64),93.8%(60/64),95.3%(61/64),92.2%(59/64),88.4%(38/43),86.0%(37/43),88.4%(38/43),87.1%(27/31)for M.cheloni-abscessus.The clinical isolates of NTM were mainly M.intracellulare,M.cheloni-abscess and M.Kansas,of which M.intracellulare and M.cheloni-abscess had high resistance to common first-line and secondline anti tuberculosis drugs,while M.Kansas had low resistance to rifampin,ethambutol,ofloxacin and capreomycin.