重庆市HIV与NTM双重感染患者的菌种分布及耐药情况

doi:10.3969/j.issn.1000-6621.2021.05.016

摘要/Abstract

摘要：

目的了解重庆市HIV与NTM双重感染患者的菌种分布及耐药情况。方法回顾性分析2019年6月至2020年6月重庆市公共卫生医疗救治中心收治的44例HIV与NTM双重感染患者的临床资料,统计其临床特征,分析NTM菌种分布情况及药物敏感性试验(简称“药敏试验”)结果。结果 44例患者中共明确鉴定出8种NTM菌种,鸟分枝杆菌占34.1%(15/44),胞内分枝杆菌占20.4%(9/44),偶发/猪分枝杆菌与堪萨斯分枝杆菌各占11.4%(5/44),龟分枝杆菌脓肿亚群与戈登分枝杆菌各占6.8%(3/44),苏尔加分枝杆菌与缓黄分枝杆菌各占2.3%(1/44),另有2例患者(4.5%)未能明确菌种。对异烟肼、对氨基水杨酸异烟肼、阿奇霉素、利福平的总体耐药率分别为81.8%(36/44)、75.0%(21/28)、61.9%(13/21)、45.5%(20/44),耐药率相对较低者为利福布汀(6.8%,3/44)和克拉霉素(11.4%,5/44)。结论重庆市HIV感染者并发NTM感染发生率较高,以鸟分枝杆菌最常见,NTM总体耐药率高,仅对利福布汀、克拉霉素耐药率相对较低。

关键词: HIV感染, 分枝杆菌,非典型性, 微生物敏感性试验, 抗药性,细菌

Abstract:

Objective To investigate the bacterial distribution and drug resistance of human immunodeficiency virus (HIV) and nontuberculous mycobacteria (NTM) co-infected patients in Chongqing. Methods The clinical data of 44 patients with HIV and NTM co-infection admitted to Chongqing Public Health Medical Center from June 2019 to June 2020 were retrospectively analyzed. The clinical characteristics of the patients, the bacteria distribution and the results of drug susceptibility test (DST) of NTM were analyzed. Results A total of eight species of NTM strains were identified in 44 patients. Mycobacterium avium accounted for 34.1% (15/44), Mycobacterium intracellular accounted for 20.4% (9/44), Mycobacterium for tuitum/suis and Mycobacterium Kansas accounted for 11.4% (5/44) respectively, Mycobacterium cheloni abscess subgroup and Mycobacterium gordonii accounted for 6.8% (3/44) respectively, Mycobacterium surga and Mycobacterium chrysogenes accounted for 2.3% (1/44) respectively, and the NTM strains in two patients (4.5%) could not be identified.The overall resistance rates to isoniazid, pasiniazide, azithromycin and rifampicin were 81.8% (36/44), 75.0% (21/28), 61.9% (13/21) and 45.5% (20/44), respectively. The relatively low resistance rates were rifabutin (6.8%, 3/44) and clarithromycin (11.4%, 5/44). Conclusion The incidence of NTM infection in HIV infected people in Chongqing is higher. Mycobacterium avium was the most common. The overall resistance rate of NTM was high, but the resistance rate to rifabutin and clarithromycin was relatively low.

Key words: HIV infection, Mycobacteria, atypical, Microbial susceptibility test, Drug resistance, bacterial

刘敏, 李明俊, 余庆, 何坤, 吴玉珊, 杨红红, 李同心. 重庆市HIV与NTM双重感染患者的菌种分布及耐药情况[J]. 中国防痨杂志, 2021, 43(5): 501-505. doi: 10.3969/j.issn.1000-6621.2021.05.016

LIU Min, LI Ming-jun, YU Qing, HE Kun, WU Yu-shan, YANG Hong-hong, LI Tong-xin. Bacteria distribution and drug resistance of co-infection patients of human immunodeficiency virus and nontuberculous mycobacteria in Chongqing[J]. Chinese Journal of Antituberculosis, 2021, 43(5): 501-505. doi: 10.3969/j.issn.1000-6621.2021.05.016

图/表 3

表1

表2

表3

不同药品在不同NTM菌株中的耐药情况

药品排序	药品名称	鸟分枝杆菌	胞内分枝杆菌	偶发/猪分枝杆菌	堪萨斯分枝杆菌	龟分枝杆菌脓肿亚群	戈登分枝杆菌	苏尔加分枝杆菌	缓黄分枝杆菌	其他类型分枝杆菌	总耐药
1	异烟肼	100.0 (15/15)	100.0 (9/9)	100.0 (5/5)	40.0 (2/5)	100.0 (3/3)	33.3 (1/3)	0.0 (0/1)	0.0 (0/1)	50.0 (1/2)	81.8 (37/44)
2	利福平	53.3 (8/15)	44.4 (4/9)	80.0 (4/5)	40.0 (2/5)	66.7 (2/3)	0.0 (0/3)	0.0 (0/1)	0.0 (0/1)	0.0 (0/2)	45.5 (20/44)
3	利福布汀	0.0 (0/15)	0.0 (0/9)	40.0 (2/5)	20.0 (1/5)	0.0 (0/3)	0.0 (0/3)	0.0 (0/1)	0.0 (0/1)	0.0 (0/2)	6.8 (3/44)
4	克拉霉素	26.7 (4/15)	0.0 (0/9)	20.0 (1/5)	0.0 (0/5)	0.0 (0/3)	0.0 (0/3)	0.0 (0/1)	0.0 (0/1)	0.0 (0/2)	11.4 (5/44)
5	乙胺丁醇	46.7 (7/15)	44.4 (4/9)	60.0 (3/5)	60.0 (3/5)	66.7 (2/3)	0.0 (0/3)	0.0 (0/1)	0.0 (0/1)	50.0 (1/2)	45.5 (20/44)
6	莫西沙星	40.0 (6/15)	55.6 (5/9)	0.0 (0/5)	60.0 (3/5)	0.0 (0/3)	0.0 (0/3)	0.0 (0/1)	0.0 (0/1)	50.0 (1/2)	34.1 (15/44)
7	利奈唑胺	60.0 (9/15)	33.3 (3/9)	40.0 (2/5)	20.0 (1/5)	0.0 (0/3)	0.0 (0/3)	0.0 (0/1)	0.0 (0/1)	0.0 (0/2)	34.1 (15/44)
8	阿米卡星	40.0 (6/15)	44.4 (4/9)	20.0 (1/5)	40.0 (2/5)	0.0 (0/3)	0.0 (0/3)	0.0 (0/1)	0.0 (0/1)	0.0 (0/2)	29.5 (13/44)
9	亚胺培南- 西司他丁	100.0 (10/10)	100.0 (7/7)	100.0 (2/2)	100.0 (1/1)	-	-	100.0 (1/1)	-	-	100.0 (21/21)
10	阿奇霉素	70.0 (7/10)	57.1 (4/7)	100.0 (2/2)	0.0 (0/1)	-	-	0.0 (0/1)	-	-	61.9 (13/21)
11	头孢西丁	50.0 (5/10)	100.0 (7/7)	50.0 (1/2)	100.0 (1/1)	-	-	0.0 (0/1)	-	-	66.7 (14/21)
12	妥布霉素	30.0 (3/10)	100.0 (7/7)	100.0 (2/2)	0.0 (0/1)	-	-	0.0 (0/1)	-	-	57.1 (12/21)
13	加替沙星	100.0 (10/10)	100.0 (7/7)	0.0 (0/2)	0.0 (0/1)	-	-	0.0 (0/1)	-	-	81.0 (17/21)
14	米诺环素	80.0 (8/10)	100.0 (7/7)	100.0 (2/2)	100.0 (1/1)	-	-	100.0 (1/1)	-	-	90.5 (19/21)
15	磺胺甲唑	100.0 (10/10)	100.0 (7/7)	100.0 (2/2)	100.0 (1/1)	-	-	100.0 (1/1)	-	-	100.0 (21/21)
16	左氧氟沙星	50.0 (4/8)	75.0 (3/4)	66.7 (2/3)	50.0 (2/4)	33.3 (1/3)	0.0 (0/3)	-	0.0 (0/1)	50.0 (1/2)	46.4 (13/28)
17	卷曲霉素	62.5 (5/8)	75.0 (3/4)	0.0 (0/3)	100.0 (4/4)	66.7 (2/3)	33.3 (1/3)	-	0.0 (0/1)	50.0 (1/2)	57.1 (16/28)
18	链霉素	50.0 (4/8)	100.0 (4/4)	100.0 (3/3)	100.0 (4/4)	66.7 (2/3)	33.3 (1/3)	-	0.0 (0/1)	50.0 (1/2)	67.9 (19/28)
19	氯法齐明	37.5 (3/8)	0.0 (0/4)	33.3 (1/3)	75.0 (3/4)	0.0 (0/3)	0.0 (0/3)	-	0.0 (0/1)	0.0 (0/2)	25.0 (7/28)
20	对氨柳酸钠盐	100.0 (8/8)	100.0 (4/4)	100.0 (3/3)	100.0 (4/4)	100.0 (3/3)	33.3 (1/3)	-	0.0 (0/1)	50.0 (1/2)	85.7 (24/28)
21	丙硫异烟胺	100.0 (8/8)	25.0 (1/4)	33.3 (1/3)	50.0 (2/4)	33.3 (1/3)	0.0 (0/3)	-	0.0 (0/1)	50.0 (1/2)	50.0 (14/28)
22	对氨基水杨酸异烟肼	75.0 (6/8)	100.0 (4/4)	100.0 (3/3)	100.0 (4/4)	100.0 (3/3)	33.3 (1/3)	-	0.0 (0/1)	0.0 (0/2)	75.0 (21/28)

表3

参考文献 17

[1]	唐神结, 高文. 临床结核病学.2版. 北京: 人民卫生出版社, 2019: 1026-1046.
[2]	Daley CL, Iaccarino JM, Lange C, et al. Treatment of Nontuberculous Mycobacterial Pulmonary Disease:An Official ATS/ERS/ESCMID/IDSA Clinical Practice Guideline. Clin Infect Dis, 2020,71(4):905-913. doi: 10.1093/cid/ciaa1125. doi: 10.1093/cid/ciaa1125 URL pmid: 32797222
[3]	Haworth CS, Banks J, Capstick T, et al. British Thoracic Society guidelines for the management of non-tuberculous mycobacterial pulmonary disease (NTM-PD). Thorax, 2017,72(Suppl 2):ii1-ii64. doi: 10.1136/thoraxjnl-2017-210927. doi: 10.1136/thoraxjnl-2020-215107 URL pmid: 33859050
[4]	郭倩, 朱召芹, 钱雪琴, 等. 上海地区艾滋病患者合并非结核分枝杆菌感染菌种分布. 中华传染病杂志, 2019,37(2):93-96. doi: 10.3760/cma.j.issn.1000-6680.2019.02.006.
[5]	Lan R, Yang C, Lan L, et al. Mycobacterium tuberculosis and non-tuberculous mycobacteria isolates from HIV-infected patients in Guangxi, China. Int J Tuberc Lung Dis, 2011,15(12):1669-1675. doi: 10.5588/ijtld.11.0036. doi: 10.5588/ijtld.11.0036 URL pmid: 22118176
[6]	Liu L, Zhang R, Tang Y, et al. The importance of non-tuberculous mycobacteria identification in Chinese patients infected with HIV. Biosci Trends, 2018,12(5):515-516. doi: 10.5582/bst.2018.01254. doi: 10.5582/bst.2018.01254 URL pmid: 30473561
[7]	中华医学会感染病学分会艾滋病丙型肝炎学组, 中国疾病预防与控制中心. 中国艾滋病诊疗指南(2018版). 中华传染病杂志, 2018,36(12):705-724. doi: 10.3760/cma.j.issn.1000-6680.2018.12.001.
[8]	中华医学会热带病与寄生虫学分会艾滋病学组. 人类免疫缺陷病毒/艾滋病患者合并非结核分枝杆菌感染诊治专家共识. 中华传染病杂志, 2019,37(3):129-138. doi: 10.3760/cma.j.issn.1000-6680.2019.03.001.
[9]	Hoefsloot W, van Ingen J, Andrejak C, et al. Nontuberculous Mycobacteria Network European Trials Group. The geographic diversity of nontuberculous mycobacteria isolated from pulmonary samples: an NTM-NET collaborative study. EurRespir J, 2013,42(6):1604-1613. doi: 10.1183/09031936.00149212.
[10]	Chou CH, Chen HY, Chen CY, et al. Clinical features and outcomes of disseminated infections caused by non-tuberculous mycobacteria in a university hospital in Taiwan, 2004—2008. Scand J Infect Dis, 2011,43(1):8-14. doi: 10.3109/00365548.2010.519345. doi: 10.3109/00365548.2010.519345 URL
[11]	Bjerrum S, Oliver-Commey J, Kenu E, et al. Tuberculosis and non-tuberculous mycobacteria among HIV-infected individuals in Ghana. Trop Med Int Health, 2016,21(9):1181-1190. doi: 10.1111/tmi.12749. doi: 10.1111/tmi.12749 URL pmid: 27383726
[12]	张汇征, 熊敏, 陈耀凯, 等. 重庆43例临床非结核分枝杆菌鉴定及药敏试验. 中国预防医学杂志, 2019,20(5):375-378. doi: 10.16506/j.1009-6639.2019.05.005.
[13]	吴跃, 邓西子, 胡凤玉, 等. 艾滋病合并非结核分枝杆菌肺病的病原谱、临床特征和耐药情况. 中华传染病杂志, 2017,35(3):142-145. doi: 10.3760/cma.j.issn.1000-6680.2017.03.004.
[14]	贾彤, 张海晴, 魏素梅, 等. 2013~2017年徐州市非结核分枝杆菌菌种鉴定、三间分布和耐药性分析. 中国临床医生杂志, 2019,47(2):173-175. doi: 10.3969/j.issn.2095-8552.2019.02.014.
[15]	秦中华, 景晔, 杜岩青, 等. 339株非结核分枝杆菌临床分离株菌种鉴定及耐药性分析. 中国防痨杂志, 2020,42(6):630-633. doi: 10.3969/j.issn.1000-6621.2020.06.017.
[16]	Kobayashi T, Nishijima T, Teruya K, et al. High Mortality of Disseminated Non-Tuberculous Mycobacterial Infection in HIV-Infected Patients in the Antiretroviral Therapy Era. PLoS One, 2016,11(3):e0151682. doi: 10.1371/journal.pone.0151682. doi: 10.1371/journal.pone.0152817 URL pmid: 27031997
[17]	Hoza AS, Mfinanga SG, Rodloff AC, et al. Increased isolation of nontuberculous mycobacteria among TB suspects in Northeastern, Tanzania: public health and diagnostic implications for control programmes. BMC Res Notes, 2016,9:109. doi: 10.1186/s13104-016-1928-3. doi: 10.1186/s13104-016-1928-3 URL pmid: 26887928

人口学特征	例数	百分率(%)
性别^a
男	34	77.3
女	10	22.7
年龄组(岁)^a
<18	0	0.0
18~59	37	84.1
60~69	7	15.9
有吸烟史	19	43.2
既往有肺结核病史	7	15.9
并发慢性基础疾病
糖尿病	2	4.5
慢性阻塞性肺疾病	2	4.5
临床症状
咳嗽	39	88.6
咳痰	34	77.3
发热	30	68.2
气促	22	50.0
咯血	0	0.0