2016-2021年唐山地区非结核分枝杆菌流行及耐药情况分析  

Analysis of the prevalence and drug resistance of non tuberculosis mycobacterium in Tangshan from 2016 to 2021

作　　者：刘海涛 田杰 韩云艳 赵俊鹏[2] Liu Haitao;Tian Jie;Han Yunyan;Zhao Junpeng(Department of Clinical Laboratory,Tangshan Seventh Hospital,Hebei Tangshan 063000,China;Department of Tuberculosis,Tangshan Center for Disease Control and Prevention,Hebei Tangshan 063000,China)

机构地区：[1]唐山市第七医院检验科,河北唐山063000 [2]唐山市疾病预防控制中心结核病防治科,河北唐山063000

出　　处：《新发传染病电子杂志》2023年第6期58-62,共5页Electronic Journal of Emerging Infectious Diseases

基　　金：河北省2022年度医学科学研究重点课题计划(20221806)。

摘　　要：目的分析唐山地区非结核分枝杆菌(non tuberculosis mycobacterium,NTM)流行及耐药情况,为NTM病的预防及治疗提供依据。方法收集2016年1月至2021年12月唐山地区NTM人群分离率及药物敏感试验结果,通过趋势检验分析NTM分离率、分析相应菌种构成比及耐药性的趋势变化。结果从2487例疑似结核病患者痰标本中分离到NTM菌株390株,分离率为15.68%,各年份NTM分离率依次为13.89%、14.12%、14.36%、17.44%、15.69%、18.37%,NTM中前3位的优势菌种为胞内分枝杆菌(62.31%)、堪萨斯分枝杆菌(18.72%)、脓肿分枝杆菌(9.49%)。单一抗NTM药物的耐药率顺位为亚胺西司(IC)(80.3%)>多西环素(DOX)(55.49%)>米诺环素(MNO)(43.35%)>磺胺甲唑(SMZ)(28.32%)>头孢西丁(FOX)(24.86%)>妥布霉素(TOB)(17.92%)>乙胺丁醇(EMB)(14.45%)>利福平(RFP)(10.98%)>阿奇霉素(AZM)(9.83%)>加替沙星(GAT)(8.67%)>利福布汀(RFb)(8.09%)>利奈唑胺(LZD)(7.51%)>克拉霉素(CLA)(4.62%)=阿米卡星(AMK)(4.62%)>莫西沙星(MXF)(1.73%)。趋势检验结果显示IC、DOX耐药率上升有统计学意义(χ^(2)=23.204,4.349,均P<0.05)。结论唐山地区NTM以胞内分枝杆菌、堪萨斯分枝杆菌、脓肿分枝杆菌为主,部分抗NTM药物的耐药率呈上升趋势,在临床中要注重NTM感染的诊断及合理用药。Objective To analyze the prevalence and drug resistance of non tuberculosis mycobacterium(NTM)in Tangshan area,and to provide a basis for the prevention and treatment of NTM disease.Method Through a retrospective study,the NTM isolation rate and drug sensitivity test results of Tangshan area from January 2016 to December 2021 were collected.The trend of NTM isolation rate and corresponding bacterial composition ratio were analyzed by trend testing.The difference in NTM drug resistance rate was compared throughχ^(2) test.Result A total of NTM 390 strains were isolated from sputum samples of 2487 suspected tuberculosis patients,and the separation rate was 15.68%.The isolation rates of NTM each year were 13.89%,14.12%,14.36%,17.44%,15.69%,and 18.37%,respectively.The top three dominant strains in NTM were M ycobacterium intracellularis(62.31%),M ycobacterium kansas(18.72%),and M ycobacterium abscessus(9.49%).The order of resistance rate of single anti NTM drugs was imipenem and cilastatin(IC)(80.3%)>doxycycline(DOX)(55.49%)>minocycline(MNO)(43.35%)>sulfamethazole(SMZ)(28.32%)>cefoxitin(FOX)(24.86%)>tobramycin(TOB)(17.92%)>ethambutol(EMB)(14.45%)>rifampin(RFP)(10.98%)>azithromycin(AZM)(9.83%)>gatifloxacin(GAT)(8.67%)>rifabutin(RFb)(8.09%)>linezolid(LZD)(7.51%)>clarithromycin(CLA)(4.62%)=amikacin(AMK)(4.62%)>moxifloxacin(MXF)(1.73%).The trend test results showed a statistically significant increase in the resistance rate to IC、DOX(χ^(2)=23.204,4.349,P<0.05).Conclusion M ycobacterium intracellularis,M ycobacterium Kansas,and M ycobacterium abscessus were the dominant NTM strains in Tangshan area.The resistance rates of some anti-NTM drugs are on the rise,and attention should be paid to the diagnosis and rational use of NTM infection in clinical diagnosis and treatment.

关 键 词：分枝杆菌 非结核分枝杆菌 药物敏感试验 分离率 耐药率 

分 类 号：R183.7[医药卫生—流行病学]