某综合性医院肺外非结核分枝杆菌病微生物学及临床特征分析  

Microbiological and clinical characteristics of extrapulmonary nontuberculous mycobacterial disease in a general hospital

作　　者：姚雨濛 鲍容 潘珏 胡必杰 YAO Yu-meng;BAO Rong;PAN Jue;HU Bi-jie(Department of Infectious Diseases,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Laboratory Medicine,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院感染性疾病科,上海200032 [2]复旦大学附属中山医院检验科,上海200032

出　　处：《中国临床医学》2023年第4期714-720,共7页Chinese Journal of Clinical Medicine

基　　金：上海市青年科技英才扬帆计划(20YF1407600).

摘　　要：目的探讨肺外非结核分枝杆菌病(extrapulmonary nontuberculous mycobacterial disease,ENTM)的微生物学和临床特征。方法回顾性查找2017年1月至2021年12月复旦大学附属中山医院微生物实验室检出ENTM标本,纳入确诊ENTM病例33例,分析人口学、微生物学、临床表现、治疗和预后特征。结果33例ENTM患者中,年龄(49±16.3)岁,23例(69.7%)为女性,1/3为免疫抑制宿主。感染类型以皮肤软组织感染、骨关节感染和播散性感染最常见(57.6%、18.2%和15.6%),51.5%(17/33)为医疗保健相关感染。病原以快速生长型非结核分枝杆菌(RGM)中的脓肿分枝杆菌复合群(42.4%)最常见。患者平均接受(3.5±0.8)种药物联合治疗,疗程6.3(4.3,9.6)个月。多数病例痊愈(69.7%)或临床好转(18.2%)。与RGM相比,缓慢生长型非结核分枝杆菌(SGM)感染者年龄更大[(60.2±15.0)岁vs(42.6±14.0)岁,P<0.05]且更多为社区获得性感染(83.3%vs 28.6%,P<0.05)。结论ENTM中最常见皮肤软组织感染,脓肿分枝杆菌复合群感染最多。SGM感染者年龄更大且更常见社区获得性感染。ENTM的治疗较为困难且缺少统一标准,需要更多研究。Objective To explore the microbiological and clinical characteristics of extrapulmonary nontuberculous mycobacterial disease(ENTM).Methods Laboratory extrapulmonary samples positive for NTM between Jan.2017 and Dec.2021 were retrospectively searched in Zhongshan Hospital,Fudan Univeristy.Thirty three confirmed ENTM cases were included.Demographic,microbiological,clinical characteristics,as well as treatment and prognosis were analyzed.Results A total of 33 confirmed ENTM cases were included,average age was(49±16.3)years,23 cases(69.7%)were female,one third of the patients were immunocompromised.Skin and soft tissue infection,bone and joint infection,and disseminated NTM disease were the most common types(57.6%,18.2%,and 15.6%).Healthcare-associated infections accounted for 51.5%(17/33)of the cases.Mycobacterium abscessus complex(42.4%)in rapidly growing mycobacteria(RGM)was the most common causative species.Patients received combination therapy with an average of(3.5±0.8)drugs for 6.3(4.3,9.6)months.Most cases recovered(69.7%)or improved clinically(18.2%).Compared with RGM,infections with SGM were seen in older individuals(60.2±15.0 vs 42.6±14.0,P<0.05)and were more often community acquired(83.3%vs 28.6%,P<0.05).Conclusions Skin and soft tissue infection is the most common type of ENTM,with Mycobacterium abscessus complex being the most important causative species.SGM infections affect older population and are more often community acquired.Treatment of ENTM is challenging and lacks standardized protocol,future researches are needed.

关 键 词：非结核分枝杆菌 肺外疾病 脓肿分枝杆菌 医疗保健相关感染 临床诊治 

分 类 号：R378[医药卫生—病原生物学]