非结核分枝杆菌分布特征及耐药性分析  

Distribution and drug resistance of nontuberculous mycobacteria

作　　者：陈锦 姚建荣[1] 王秀袖[1] CHEN Jin;YAO Jian-rong;WANG Xiu-xiu(Department of Laboratory Medicine,The First People′s Hospital of Guangyuan City,Guangyuan,Sichuan 628000,China)

机构地区：[1]四川省广元市第一人民医院检验科,四川广元628000

出　　处：《公共卫生与预防医学》2022年第3期134-137,共4页Journal of Public Health and Preventive Medicine

摘　　要：目的 分析非结核分枝杆菌分布特征及耐药性情况,旨在为临床治疗选择更针对性药物。方法 收集2019年4月至2021年2月广元市第一人民医院住院患者临床资料,对其进行非结核分枝杆菌培养与菌种鉴定,并对抗结核药物做药敏试验,分析结合及非结核分枝杆菌对一线抗结核药的耐药性。结果 共分离出1 326株分枝杆菌株,其中1 154株(87.03%)结核分枝杆菌,172株(12.97%)非结核分枝杆菌。在非结核分枝杆菌中共检出9种菌株,包括堪萨斯分枝杆菌、鸟分枝杆菌复合群等缓慢生长群,所属I~III群;及龟分枝杆菌、耻垢分枝杆菌等快速生长群,所属IV群。其中以鸟分枝杆菌复合群、龟分枝杆菌为主,分别占比26.16%、36.63%。药敏试验显示,主要NTM中鸟分枝杆菌复合群对链霉素耐药率达100.00%,龟分枝杆菌对异烟肼、利福平、链霉素耐药率至100.00%,耻垢分枝杆菌与脓肿分枝杆菌对大多数抗菌药的耐药率均达到100.00%;主要NTM病菌对克拉霉素的耐药率相对较低。缓慢与快速生长群对异烟肼及克拉霉素的敏感率差异无统计学意义(P>0.05);缓慢生长群对阿米卡星、克拉霉素、利福布汀敏感率超过50.00%,分别为62.86%、92.86%、72.86%;快速生长群仅对克拉霉素敏感率超过50.00%,为87.25%;缓慢生长群对其他抗菌药敏感率高于快速生长群(P<0.05)。结核分枝杆菌对一线抗结核药的耐药性均明显低于非结核分枝杆菌,差异有统计学意义(P<0.05)。结论 非结核分枝杆菌的耐药性较高,尤其是快速生长群,临床应根据药敏试验制定针对合理的给药方案进行治疗。Objective To analyze the distribution characteristics and drug resistance of nontuberculous mycobacteria(NTM),and to provide guidance for the selection of targeted agents in clinical treatment. Methods The clinical data of inpatients in our hospital from April 2019 to February 2021 were collected, the culture and strain identification of non tuberculosis mycobacteria were carried out, the drug sensitivity test of anti tuberculosis drugs was carried out, and the drug resistance of non tuberculosis mycobacteria to first-line anti tuberculosis drugs was analyzed. Results A total of 1 326 strains of mycobacterium were isolated, including 1 154(87.03%)strains of mycobacterium tuberculosis and 172(12.97%)strains of non-mycobacterium tuberculosis.Nine species of nontuberculous mycobacteria were detected, including slow-growing mycobacteria such as Mycobacterium kansasii and Mycobacterium avium-intracellulare complex, belonging to Groups I-III,and fast-growing mycobacteria such as Mycobacterium chelonae and Mycobacterium smegmatis, belonging to Group IV.Among them, Mycobacterium avium-intracellulare complex and Mycobacterium chelonae were dominant, accounting for 26.16%and 36.63%,respectively.Drug susceptibility tests showed that the resistance rate of Mycobacterium avium-intracellulare complex to streptomycin was 100.00%,the drug resistance rate of Mycobacterium chelonae to isoniazid, rifampicin and streptomycin was 100.00%,and the drug resistance rate of Mycobacterium smegmatis and Mycobacterium abscessus to most antibacterial drugs was 100.00%.The resistance rate of major NTM bacteria to clarithromycin was relatively low.There was no statistically significant difference in the susceptibility rates of slow and fast-growing mycobacteria to isoniazid and clarithromycin(P>0.05);The susceptibility rates of slow-growing mycobacteria to amikacin, clarithromycin and rifambutin were 62.86%,92.86%and 72.86%,all above 50.00%.The susceptibility rate of the fast-growing mycobacteria to clarithromycin was also more than 50.00%,bein

关 键 词：非结核分枝杆菌 龟分枝杆菌 鸟分枝杆菌复合群 药敏试验 耐药性 

分 类 号：R181[医药卫生—流行病学]