2015—2020年云浮地区非结核分枝杆菌感染及耐药情况分析

Analysis on Infection and Resistance of Non-tuberculosis Mycobacteriumin in Yunfu Area From 2015 to 2020

目的 分析云浮地区结核患者和疑似结核患者中非结核分枝杆菌(NTM)的感染和耐药情况。方法 收集2015—2020年云浮地区分枝杆菌痰培养阳性的菌株2 422株,利用对硝基苯甲酸(PNB)培养基生长试验初步菌种鉴别结核分枝杆菌复合群和非结核分枝杆菌,采用比例法对异烟肼(INH)、利福平(RFP)、乙胺丁醇(EMB)、链霉素(SM)、氧氟沙星(OFX)、卡那霉素(KM)、对氨基水杨酸(PAS)、卷曲霉素(CPM)、丙硫异烟胺(PTO)9种抗结核药物进行药物敏感性试验。结果 2015—2020年云浮地区NTM检出率为3.84%(93/2 422)。各年度NTM的检出率差异有统计学意义(χ^(2)=11.736,P=0.033)。各市县区NTM的检出率差异有统计学意义(χ^(2)=40.906,P=0.000),NTM检出率最高的是云浮市区(8.24%),NTM检出率最低的是云安区(0.51%)。NTM感染人群男性多于女性,男女性别比例为2.21∶1,以61~70岁者最多。NTM对一线抗结核药物的耐药率为95.70%,其中单耐药率为3.23%(3/93),耐多药率为58.06%(54/93),多耐药率为34.41%(32/93)。耐药顺位为INH(93.55%)、EMB(81.72%)、SM(69.89%)和RFP(58.06%)。NTM对二线抗结核药物的耐药率为94.62%,耐药顺位为PAS(88.17%)、OFX(54.84%)、PTO(51.61%)、CPM(45.16%)和KM(40.86%)。结论 云浮地区NTM检出率虽低于国内平均水平但高于省内平均水平,故对云浮地区NTM感染的防控仍然不容忽视。云浮地区NTM感染人群主要为60岁以上人群,男性多于女性,需要积极加强全民,特别是男性老年人的健康教育。NTM对抗结核药物普遍存在耐药现象,需要积极开展NTM菌种鉴定和药物敏感性试验来提高NTM病的诊断和治疗水平。

Objective To analyze the infection and drug resistance of non-tuberculous mycobacteria(NTM)in TB patients and suspected TB patients in Yunfu area.Methods To collecte 2422 sputum culture-positive strains which from Yunfu area during 2015 to 2020.Mycobacterium tuberculosis complex and non-tuberculous mycobacteria were identified by pnitrobenzoic acid(PNB)culture medium growth experiment.Nine antituberculosis drugs which include isoniazid(INH),rifampicin(RFP),ethambutol(EMB),streptomycin(SM),ofloxacin(OFX),kanamycins(KM),para-aminosalicylic acid(PAS),capreomycin(CPM)and propylthionamine(PTO)were tested by drug susceptibility test using a proportional method.Results The detection rate of NTM in Yunfu area was 3.84%(93/2422)from 2015 to 2020.There was significant difference in the detection rate of NTM among different years(χ^(2)=11.736,P=0.033).There was significant difference in the detection rate of NTM among different districts(χ^(2)=40.906,P=0.000).The highest detection rate of NTM was in the city of Yunfu(8.24%),and the lowest detection rate of NTM was in Yun'an district(0.51%).The male-female ratio of NTM infection was 2.21∶1,the highest was in 61-70 years old.The resistance rate of NTM to first-line anti-tuberculosis was 95.70%.The single drug resistance rate was 3.23%(3/93),the multidrug-resistant rate was 58.06%(54/93),and the multiple drug resistance rate was 34.41%(32/93).The order of resistance was INH(93.55%),EMB(81.72%),SM(69.89%)and RFP(58.06%).The resistance rate of NTM to second-line anti-tuberculosis was 94.62%,and the order of resistance was PAS(88.17%),OFX(54.84%),PTO(51.61%),CPM(45.16%)and KM(40.86%).Conclusion The detection rate of NTM in Yunfu area is lower than the national average but higher than the provincial average,so the prevention and control of NTM infection in Yunfu area should not be ignored.The NTM infected people in Yunfu area are mainly people over 60 years old,more males than females.It is necessary to strengthen the health education of the whole people,especially the old men.The drug resistance of NTM to anti-tuberculosis drugs is common,so it is necessary to carry out NTM strain identification and drug susceptibility test to improve the diagnosis and treatment of NTM disease.