综合性医院非结核分枝杆菌菌种分布及其耐药性  

Distribution and drug resistance of species of non-tuberculous Mycobacteria from a general hospital

作　　者：鲍容 沈佳瑾 陈裕 缪青 姚雨濛 王蓓丽 潘柏申 郭玮 胡必杰 BAO Rong;SHEN Jia-jin;CHEN Yu;MIAO Qing;YAO Yu-meng;WANG Bei-li;PAN Bai-shen;GUO Wei;HU Bi-jie(Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院检验科,上海200032 [2]复旦大学附属中山医院感染性疾病科,上海200032 [3]复旦大学附属中山医院感染管理科,上海200032

出　　处：《中华医院感染学杂志》2025年第2期202-206,共5页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金面上项目(82072325);复旦大学附属中山医院临床研究专项(ZSLCYJ202309)。

摘　　要：目的了解综合性医院非结核分枝杆菌(NTM)感染患者临床分离NTM菌种类型,分析抗菌药物敏感性,为临床早期诊断和治疗提供依据。方法收集2023年1—12月就诊于复旦大学附属中山医院感染性疾病科NTM感染患者NTM临床分离株,通过基质辅助激光解析/电离飞行时间质谱进行菌种鉴定,采用微量肉汤稀释法检测抗菌药物敏感性。结果共收集NTM感染患者临床NTM分离株99株,其中快速生长分枝杆菌(RGM)30株,包括脓肿分枝杆菌28株、偶发分枝杆菌2株,缓慢生长分枝杆菌(SGM)69株,包括胞内分枝杆菌55株、鸟分枝杆菌8株、堪萨斯分枝杆菌6株。鸟-胞内分枝杆菌复合群(MAC)对一线药物克拉霉素和阿米卡星较敏感,对二线药物利奈唑胺和莫西沙星耐药率>60.00%。所有RGM对阿米卡星高度敏感(100.00%),对多西环素耐药率最高(86.67%)。脓肿分枝杆菌对多种抗菌药物高度耐药,对克拉霉素存在诱导耐药。结论NTM菌种分布以胞内分枝杆菌和脓肿分枝杆菌为主。SGM和RGM分离株耐药性存在一定差异。NTM菌种鉴定和药物敏感性试验有助于综合性医院NTM感染患者的精准诊疗。OBJECTIVE To observe the species of clinical isolates of non-tuberculous Mycobacteria(NTM)from the patients with NTM infection in a general hospital and analyze the drug susceptibility of the strains so as to provide bases for early clinical diagnosis and treatment.METHODS The clinical isolates of NTM were collected from the patients with NTM infection who were treated in department of infectious diseases of Zhongshan Hospital,Fudan University from Jan.2023 to Dec.2023.The species of the NTM strains were identified by matrix-assisted laser desorption ionization-time-of-flight(MALDI-TOF)mass spectrometry,and the drug susceptibility testing was performed for the strains by means of microbroth dilution method.RESULTS Totally 99 strains of clinical NTM isolates were collected,30 of which were rapid growth Mycobacteria(RGM),including 28 strains of Mycobacterium abscessus and 2 streains of Mycobacterium fortuitum;69 were slow growth Mycobacteria(SGM),including 55 strains of Mycobacterium intracellulare,8 strains of Mycobacterium avium and 6 strains of Mycobacterium kansasii.The M.avium-intracellulare complex(MAC)strains were highly sensitive to frontline drugs such as clarithromycin and amikacin,and the drug resistance rates to the second-line drugs such as linezolid and moxifloxacin were greater than 60.00%.All of the RGM strains were highly sensitive to amikacin(100.00%),and the drug resistance rate to doxycycline was the highest(86.67%).The M.abscessus strains were highly resistant to various types of antibiotics and showed induced drug resistance to clarithromycin.CONCLUSIONS M.intracellulare and M.abscessus are the predominant species of NTM.There is certain difference in the drug resistance between the SGM strains and the RGM strains.The identification of species of NTM and drug susceptibility testing may facilitate the precise diagnosis and treatment of the patients with NTM infection in the general hospital.

关 键 词：非结核分枝杆菌 胞内分枝杆菌 脓肿分枝杆菌 鉴定 耐药性 

分 类 号：R378.91[医药卫生—病原生物学]