乐清地区308株非结核分枝杆菌菌种鉴定、分布及耐药情况研究

Identification,distribution and drug resistance of 308 strains of nontuberculous Mycobacterium

目的了解乐清地区非结核分枝杆菌(NTM)菌种鉴定、分布及耐药性情况。方法收集乐清市人民医院2018年1月至2022年12月入院患者的18006份痰、肺泡灌洗液、创口分泌物、肺穿刺组织和胸水等临床标本进行培养并鉴定菌种,采用微量肉汤稀释法进行药敏实验。结果共分离出308株NTM,其中从痰培养中分离191株(占62.1%),从肺泡灌洗液中分离105株(占34.1%)。308株中来自女性患者209株(67.9%),来自男性患者99株(32.1%),年龄分布为50~70岁的患者最多,占比52.9%。共检测到19种NTM,其中以胞内分枝杆菌184株(59.7%)为主,脓肿分枝杆菌45株(14.6%)为次,鸟分枝杆菌17株(5.5%)。胞内分枝杆菌对克拉霉素和阿米卡星有较好的敏感性,敏感率均为95.6%。而对利奈唑胺和莫西沙星的耐药程度较高,耐药率均高于50.0%。鸟分枝杆菌对利奈唑胺的耐药率较高,达到69.2%。除鸟-胞内分枝杆菌复合群外的其他慢生长NTM,克拉霉素、利福平、阿米卡星、利福布汀有较好的敏感性,敏感率均>78.0%。脓肿分枝杆菌对阿米卡星、克拉霉素的敏感性较好,敏感率分别为100.0%和70.0%;对多西环素、莫西沙星、环丙沙星和复方新诺明,耐药率均为100.0%;对亚胺培南和妥布霉素的耐药率均为70.0%。除脓肿分枝杆菌外的其他快生长非结核分枝杆菌,对亚胺培南、妥布霉素、多西环素、环丙沙星和复方新诺明,耐药率≥80.0%。结论本院分离出的NTM以胞内分枝杆菌、脓肿分枝杆菌和鸟分枝杆菌为主,对阿米卡星、克拉霉素具有高度敏感性,对多西环素高度耐药,为提高乐清地区NTM的精准诊疗水平提供支持。

Objective To identify and analyze the distribution trend and drug resistance of clinical isolated nontuberculous Mycobacteria(NTM).Methods Clinical samples of sputum,alveolar lavage fluid,wound secretion,lung puncture tissue,and pleural effusion were collected from 18006 patients admitted to Yueqing People's Hospital from January 2018 to December 2022.The samples were cultured,the bacterial strains were identified,and the drug susceptibility was tested by broth microdilution method.Results A total of 308 strains of NTM were isolated,of which 191 were isolated from sputum samples accounting for 62.1%,and 105 were isolated from bronchoalveolar lavage fluid accounting for 34.1%.Among the 308 patients,209 strains(67.9%)were from female patients,and 99 strains(32.1%)were from male patients;and from patients aged 50-70 years accounted for 52.9%(n=163).A total of 19 kinds of NTM were detected,of which 184(59.7%)were Mycobacterium intracellulare,45(14.6%)were Mycobacterium abscessus,and 17(5.5%)were Mycobacterium avium.Mycobacterium intracellulare strains were highly sensitive to clarithromycin and amikacin with a sensitivity rate of 95.6%.However,the resistance to linezolid and moxifloxacin was very high with a resistance rate higher than 50.0%.The resistance rate of Mycobacterium avium to linezolid was high,reaching 69.2%.The susceptibility rates of slow-growing NTM(except Mycob-acterium Avium-Intracellulare complex)to clarithromycin,rifampicin,amikacin,and rifabutin were higher than 78.0%.The sensitivity of Mycobacterium abscessus to amikacin and clarithromycin was 100.0%and 70.0%,respectively;the resistance rates to doxycycline,moxifloxacin,ciprofloxacin,and trimethoprim-sulfamethoxazole were 100.0%;the resistance rate to imipenem and tobramycin was 70.0%.For other fast-growing nontuberculous mycobacteria,the rates of resistance to imipenem,tobramycin,doxycycline,ciprofloxacin,and trimethoprim-sulfamethoxazole were more than 80.0%.Conclusion The NTM isolated in this study are mainly Mycobacterium intracellulare,Mycobacterium abscessus,and Mycobacterium avium,which are highly sensitive to amikacin and clarithromycin and highly resistant to doxycycline,which provided support for impnving the precision diagnosis and treatment level of NTM in Yueqing area.