非结核分枝杆菌肺病患者下呼吸道感染病原菌分布及耐药性分析  

Distribution and drug resistance of pathogenic bacteria causing lower respiratory tract infection in patients with non-tuberculosis Mycobacterium pulmonary disease

作　　者：郭明日[1,2,3] 张丽霞[1,2] 周洪经[1,2] 冯冉冉[1,2] 李志媛[1,2] 

机构地区：[1]天津市海河医院检验科 [2]天津市呼吸疾病研究所 [3]国家中医药管理局中医药防治传染病重点研究室,天津市300350

出　　处：《中华医院感染学杂志》2016年第20期4641-4644,共4页Chinese Journal of Nosocomiology

基　　金：天津市卫生局科技基金项目资助(2014KZ035)

摘　　要：目的回顾性分析天津市非结核分枝杆菌(NTM)肺病患者的NTM菌种分布及耐药特点,为NTM肺病及其合并的其他病原菌感染治疗提供依据。方法选取2014年5月-2015年11月医院结核科确诊62例NTM肺病患者下呼吸道样本,进行NTM培养、菌种鉴定和抗结核药物耐药性测定,并对其样本进行普通细菌学培养,VITEK-2Compact全自动微生物鉴定系统进行细菌鉴定和药敏试验。结果 NTM共鉴定出7个菌种,以胞内分枝杆菌、龟/脓肿分枝杆菌为主,分别占38.7%、32.3%,NTM对常规的抗结核药物大多显现为高度耐药,尤其是对链霉素、异烟肼、对氨基水杨酸等,但不同的NTM菌种对其仍存在一定差异;NTM肺病患者下呼吸道样本共检出36株病原菌,其中革兰阴性杆菌21株,占58.3%,革兰阳性球菌仅2株金黄色葡萄球菌,占5.6%,真菌13株,占36.1%;革兰阴性菌对丁胺卡那霉素、头孢哌酮/舒巴坦、环丙沙星等耐药率低于5.7%,2株金黄色葡萄球菌对常规的16种抗菌药物均敏感,13株真菌对两性霉素B、伊曲康唑、5-氟胞嘧啶等均敏感。结论 NTM对常规抗结核药物耐药率高,需根据药敏结果合理选择抗菌药物并积极探索抗NTM的新药;NTM肺病患者下呼吸道感染的病原菌以革兰阴性菌为主,革兰阳性菌较少,应根据药敏结果合理选择抗菌药物。OBJECTIVE To retrospectively analyze the distribution and drug resistance of non-tuberculosis Myco- bacteria （NTM） isolated from the patients with NTM pulmonary disease in Tianjin so as to provide guidance for treatment of the NTM pulmonary disease and its complication With other species of pathogens infections. METHODS A total of 62 patients who were diagnosed with NTM in the department of tuberculosis from May 2014 to Nov 2015 were enrolled in the study, then the lower respiratory tract specimens were collected for culture of NTM, the strains were identified, the drug resistance to antituberculosis drugs was determined, the common bac- teriological culture was conducted for the specimens, and the bacterial identification and drug susceptibility testing were performed by using VITEK-2 Compact automatic microorganism identification system. RESULTS Totally 7 species of NTM were identified, and the Mycobacterium intracellulare and Mycobacterium chelonei-abscessus ac- counted for 38.7 % and 32.3 %, respectively. The NTM strains were highly resistant to most of the antituberculo- sis drugs, especially to streptomycin, isoniazid, aminosalicylic acid, etc; however, the different species of NTM varied in the drug resistance. A total of 36 strains of pathogens were isolated from the lower respiratory tract spec- imens obtained from the patients with NTM pulmonary disease, including 21 （58. 3%） strains of the gram-nega- tive bacilli, the gram-positive cocci （only 2 strains of Staphylococcus aureus）, and 13 （36.1%） strains of fungi. The drug resistance rates of the gram-negative bacteria to amikacin, cefoperazone-sulbactam, and ciprofloxacin were less than 5.7%; the two strains of S. aureus were susceptible to the 16 kinds of commonly used antibiotics;the 13 strains of fungi were susceptible to amphotericin B, itraconazole, and 5-fluorocytosine. CONCLUSION The NTM strains are highly resistant to the conventional antituberculosis drugs, and it is necessary to reasonably use antibiotics and develop new antitu

关 键 词：非结核分枝杆菌 菌种鉴定 耐药性 

分 类 号：R378[医药卫生—病原生物学]