13种抗生素对快生长分枝杆菌的体外抑菌效果评价

doi:10.3969/j.issn.1000-6621.2021.09.015

摘要/Abstract

摘要：

目的评价快生长分枝杆菌(rapidly growing mycobacteria,RGM)临床分离株对13种抗生素的敏感性特征。方法收集首都医科大学附属北京胸科医院2015年1月至2019年12月从临床样本中分离出的98株RGM,包括25株偶发分枝杆菌、70株脓肿分枝杆菌和3株龟分枝杆菌。使用Sensititre RAPMYCO药敏板测定13种抗生素(阿米卡星、妥布霉素、阿莫西林-克拉维酸、头孢西丁、亚胺培南、环丙沙星、莫西沙星、克拉霉素、利奈唑胺、米诺环素、多西霉素、替加环素、甲氧苄啶-磺胺甲噁唑)对98株RGM临床分离株的体外抑菌活性。结果在所测定的13种抗生素中,阿米卡星对所检测的3种RGM临床分离株的体外抑菌活性最佳,对偶发分枝杆菌和脓肿分枝杆菌临床分离株的敏感率分别100.0%(25/25)和90.0%(63/70)。与多西环素、米诺环素相比,替加环素对RGM临床分离株的体外抑菌效果更好,对偶发分枝杆菌和脓肿分枝杆菌临床分离株的敏感率分别为100.0%(25/25)和72.9%(51/70)。莫西沙星和环丙沙星对偶发分枝杆菌临床分离株表现出较强的抑菌活性,敏感率分别为100.0%(25/25)和92.0%(23/25),而对脓肿分枝杆菌临床分离株几乎没有体外抑菌活性,耐药率均为95.7%(67/70)。此外,几乎所有检测的RGM临床分离株均对头孢西丁、多西环素、利奈唑胺、亚胺培南和甲氧嘧啶-磺胺甲噁唑耐药。结论阿米卡星、替加环素和克拉霉素对脓肿分枝杆菌和偶发分枝杆菌临床分离株具有较好的体外抑菌活性,但在不同菌株间依然存在差异,需要对每个菌种或临床分离菌株进行单独的药物敏感性试验。

关键词: 分枝杆菌,非典型性, 快生长分枝杆菌, 微生物敏感性试验, 抗药性, 评价研究

Abstract:

Objective To evaluate the susceptibility characteristics of clinical isolates of rapidly growing mycobacteria (RGM) to 13 antibiotics. Methods A total of 98 isolates of RGM recruited from Beijing Chest Hospital, Capital Medical University between January 2015 and December 2019 were collected, including 25 Mycobacterium (M.) fortuitum, 70 M.abscessus and 3 M.chelonae. Sensititre RAPMYCO MIC plate was used to determine 13 antibiotics (amikacin, tobramycin, amoxicillin-clavulanic acid, cefoxitin, imipenem, ciprofloxacin, moxifloxacin, clarithromycin, linezolid, minocycline, doxycycline, tigecycline, trimethoprim-sulfamethoxazole) in vitro antibacterial activity against the 98 RGM clinical isolates. Results Among the 13 tested antibiotics, amikacin had the best in vitro antibacterial activity against three RGM clinical isolates tested, the sensitivity rates to M.fortuitum and M.abscessus were 100.0% (25/25) and 90.0% (63/70), respectively. In vitro antibacterial effect of tigecycline on RGM clinical isolates was better than the effects of doxycycline and minocycline, and the sensitivity rates to M.fortuitum and M.abscessus were 100.0% (25/25) and 72.9% (51/70), respectively. Moxifloxacin and ciprofloxacin showed strong antibacterial activity against M.fortuitum, with sensitivity rates of 100.0% (25/25) and 92.0% (23/25), respectively; however, for M.abscessus branches, they had almost no antibacterial activity in vitro, and the drug resistance rate was 95.7% (67/70). In addition, almost all tested RGM clinical isolates were resistant to cefoxitin, doxycycline, linezolid, imipenem, and methoxazole-sulfamethoxazole. Conclusion Amikacin, tigecycline and clarithromycin had good in vitro antimicrobial activity against M.abscessus and M.fortuitum, but there were still differences among different strains. Separate drug sensitivity test is necessary to be carried out for each strain or clinical strain.

Key words: Mycobacteria,atypical, Rapidly growing mycobacteria, Microbial sensitivity tests, Drug resistance, Evaluation studies

于霞, 任汝颜, 文舒安, 梁倩, 董玲玲, 黄海荣. 13种抗生素对快生长分枝杆菌的体外抑菌效果评价[J]. 中国防痨杂志, 2021, 43(9): 947-951. doi: 10.3969/j.issn.1000-6621.2021.09.015

YU Xia, REN Ru-yan, WEN Shu-an, LIANG Qian, DONG Ling-ling, HUANG Hai-rong. Evaluation of in vitro antibacterial effects of 13 antibiotics against rapidly growing mycobacteria[J]. Chinese Journal of Antituberculosis, 2021, 43(9): 947-951. doi: 10.3969/j.issn.1000-6621.2021.09.015

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参考文献 14

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药品	龟分枝杆菌 (ATCC14472)	偶发分枝杆菌 (ATCC6481)	脓肿分枝杆菌 (ATCC19977)
阿米卡星	32	1	8
妥布霉素	>8	1	>8
阿莫西林- 克拉维酸	>64/32	>4/32	>64/32
头孢西丁	128	32	>128
亚胺培南	>64	16	>64
环丙沙星	>4	0.5	>4
莫西沙星	8	0.25	>8
克拉霉素	16	4	0.12
利奈唑胺	32	>32	32
米诺环素	>8	1	>8
多西霉素	>16	0.5	>16
替加环素	1	0.12	1
甲氧苄啶- 磺胺甲噁唑	>8/152	8/152	>8/152

药品	MIC 临界浓度(μg/ml)^a			偶发分枝杆菌(25株)
药品	敏感	临界浓度	耐药	MIC范围 (μg/ml)	MIC₅₀ (μg/ml)	MIC₉₀ (μg/ml)	敏感菌株[株 (敏感率,%)]
阿米卡星	≤16	32	≥64	1~2	1	1	25(100.0)
妥布霉素	≤2	4	≥8	4~>16	16	>16	0(0.0)
阿莫西林-克拉维酸	-	-	-	64/32	64/32	64/32	-
头孢西丁	≤16	32~64	≥128	64~>128	64	128	0(0.0)
亚胺培南	≤4	8~16	≥32	32~>64	>64	>64	0(0.0)
环丙沙星	≤1	2	≥4	0.12~4	0.12	0.25	23(92.0)
莫西沙星	≤1	2	≥4	0.25~0.5	0.25	0.25	25(100.0)
克拉霉素	≤2	4	≥8	1~>16	>16	>16	1(4.0)
利奈唑胺	≤8	16	≥32	8~>32	32	>32	1(4.0)
米诺环素	≤1	2~4	≥8	1~>8	>8	>8	2(8.0)
多西霉素	≤1	2~4	≥8	0.25~>16	>16	>16	3(12.0)
替加环素^b	-	-	-	0.12~1	0.25	0.25	25(100.0)
甲氧苄啶-磺胺甲噁唑	≤2/38	-	≥4/76	1/19-4/76	4/76	4/76	5(20.0)

药品	MIC 临界浓度(μg/ml)^a			脓肿分枝杆菌(70株)
药品	敏感	临界浓度	耐药	MIC范围 (μg/ml)	MIC₅₀ (μg/ml)	MIC₉₀ (μg/ml)	敏感菌株[株 (敏感率,%)]
阿米卡星	≤16	32	≥64	1~32	16	16	63(90.0)
妥布霉素	≤2	4	≥8	2~>16	16	>16	1(1.4)
阿莫西林-克拉维酸	-	-	-	64/32~>64/32	64/32	>64/32	-
头孢西丁	≤16	32~64	≥128	16~>128	128	>128	1(1.4)
亚胺培南	≤4	8~16	≥32	8~>64	>64	>64	0(0.0)
环丙沙星	≤1	2	≥4	0.12~>4	>4	>4	3(4.3)
莫西沙星	≤1	2	≥4	2~>8	>8	>8	3(4.3)
克拉霉素	≤2	4	≥8	0.06~>16	1	16	43(61.4)
利奈唑胺	≤8	16	≥32	2~>32	32	>32	2(2.9)
米诺环素	≤1	2~4	≥8	1~>8	>8	>8	2(2.9)
多西霉素	≤1	2~4	≥8	0.12~>16	>16	>16	2(2.9)
替加环素^b	-	-	-	0.06~>4	1	4	51(72.9)
甲氧苄啶-磺胺甲噁唑	≤2/38	-	≥4/76	0.25/4.75~8/152	>8/152	>8/152	3(4.3)

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