嘉兴地区肺部感染常见非结核分枝杆菌耐药情况分析

Analysis of drug resistance of common nontuberculous Mycobacteria in pulmonary infection in Jiaxing area

目的 探讨分析嘉兴地区常见非结核分枝杆菌的耐药情况。方法 收集本地区2019年3月-2021年6月呼吸道样本分离得到的非结核分枝杆菌,以基质辅助激光解析电离飞行时间质谱(MALDI-TOFMS)进行菌种鉴定,对常见菌种进行微量肉汤稀释法药敏试验。结果 168株非结核分枝杆菌中以胞内分枝杆菌、脓肿分枝杆菌和堪萨斯分枝杆菌为主。胞内分枝杆菌对克拉霉素敏感率为92.77%,利奈唑胺和莫西沙星耐药率分别为65.06%和71.08%;脓肿分枝杆菌克拉霉素初始敏感率为100.00%,诱导耐药率为84.85%,阿米卡星敏感率为87.88%,头孢西丁中介率为93.94%,对强力霉素、环丙沙星、莫西沙星等耐药率在90%以上。堪萨斯分枝杆菌对克拉霉素、利福平、利奈唑胺等均表现出较高的敏感性。结论 本地区胞内分枝杆菌和脓肿分枝杆菌耐药情况严重,临床治疗非结核分枝杆菌病应根据药敏结果制定合理的多药物治疗方案。

Objective To investigate and analyze the drug resistance of common nontuberculosis Mycobacteria in Jiaxing area.Methods Nontuberculous Mycobacteria isolated from respiratory tract samples in this area from March 2019 to June 2021 were collected. The strains were identified by matrix assisted laser desorption ionization time of flight mass spectrometry(MALDI-TOF MS), and the drug sensitivity of common strains was tested by micro broth dilution method.Results Among 168 strains of nontuberculous Mycobacteria, 83 strains ofM. intracelluare(49. 40%), 33 strains ofM. abscessus(19. 64%) and 32 strains ofM. kansasii(19. 05%). The sensitivity rate ofM. intracelluareto clarithromycin was 92. 77%, and the resistance rates of linezolid and moxifloxacin were 65. 06% and 71. 08%, respectively;The initial sensitivity rate ofM. abscessusto clarithromycin was 100. 00%, the induced resistance rate was 84. 85%, the sensitivity rate of amikacin was 87. 88%, the mediation rate of cefoxitin was 93. 94%, and the resistance rate to doxycycline, ciprofloxacin and moxifloxacin was more than 90%.M. kansasii showed high sensitivity to clarithromycin, rifampicin and linezolid.Conclusion The drug resistance ofM. intracelluareand M. abscessusis serious in this area. A reasonable multi drug treatment scheme should be formulated according to the drug sensitivity results in the clinical treatment of nontuberculous Mycobacterial disease.