山东地区439株非结核分枝杆菌临床分离株菌种鉴定及耐药情况

doi:10.3969/j.issn.1000-6621.2021.05.019

摘要/Abstract

摘要：

为分析山东地区非结核分枝杆菌(non-tuberculous mycobacterium,NTM)临床分离株菌种分布及耐药情况,笔者选取2015年1月至2019年12月山东省胸科医院收治的354例NTM肺病患者的临床分离株进行菌种鉴定,并分析菌株对异烟肼、利福平、乙胺丁醇等25种药品的耐药情况(2018年前采用绝对浓度法检测,2018年及以后采用微孔板法检测)。结果显示,354株NTM临床分离株共鉴定出12种菌种,主要以胞内分枝杆菌(69.77%,247/354)、堪萨斯分枝杆菌(12.71%,45/354)及脓肿分枝杆菌(7.63%,27/354)为主。男性和≥45岁患者构成比[分别为64.97%(230/354)和84.75%(300/354)]明显高于女性和<45岁患者[分别为35.03%(124/354)和15.25%(54/354)],差异均有统计学意义(χ²值分别为18.639和42.363,P值均<0.01)。183株(51.69%)NTM分离株行药物敏感性试验,其中,50株采用绝对浓度法,结果显示:除对乙胺丁醇的耐药率为52.00%(26/50)外,对其余9种药品(异烟肼、利福平、链霉素、卷曲霉素、左氧氟沙星、对氨基水杨酸、阿米卡星、卡那霉素、氧氟沙星)的耐药率均≥86.00%;133株采用微孔板法,结果显示:对莫西沙星、阿米卡星及克拉霉素的耐药率均较低[分别为0.00%(0/133)、3.76%(5/133)、6.02%(8/133)],对亚胺培南/西司他丁、多西环素、米诺环素、复方磺胺甲噁唑的耐药率均较高[分别为98.50%(131/133)、91.73%(122/133)、90.23%(120/133)、90.23%(120/133)];且不同NTM菌种对部分药品的耐药性存在种间差异。

关键词: 分枝杆菌,非典型性, 细菌分型技术, 微生物敏感性试验, 数据说明,统计

Abstract:

In order to analyze the distribution and drug resistance of clinical isolates of non-tuberculosis mycobacterium (NTM) in Shandong, 354 clinical isolates from patients with NTM lung disease in Shandong Provincial Chest Hospital from January 2015 to December 2019 were selected for strain identification, and drug resistance of the isolates to 25 drugs such as isoniazid, rifampicin and ethambutol was also analyzed (absolute concentration method was used before 2018, and microplate method was used after 2018). The results showed that 12 species were identified from 354 clinical isolates of NTM, and the main strains were Mycobacterium intracellular (69.77%, 247/354), Mycobacterium kansasii (12.71%, 45/354) and Mycobacterium abscessus (7.63%, 27/354). Of the patients, the proportion of the male was significantly higher than that of the female ((64.97% (230/354) vs. 35.03% (124/354), χ ²=18.639, P<0.01);the proportion of aged ≥45 years old was significantly higher than that of aged <45 years old (84.75% (300/354) vs. 15.25% (54/354), χ ²=42.363, P<0.01). One hundred and eighty-three (51.69%) NTM isolates were tested for drug sensitivity, of which 50 isolates were tested by absolute concentration method. The results showed that the drug resistance rate to ethambutol was 52.00% (26/50), and the drug resistance rates of the other 9 drugs (isoniazid, rifampicin, streptomycin, capreomycin, levofloxacin, p-aminosalicylic acid, amikacin, kanamycin, ofloxacin) were all higher than 86.00%. The other 133 isolates were tested by microplate method. The results showed that the drug resistance rates of moxifloxacin, amikacin and clarithromycin were all low (0.00% (0/133), 3.76% (5/133) and 6.02% (8/133), respectively), while the drug resistance rates of imipenem/cilastatin, doxycycline, minocycline and cotrimoxazole were all high (98.50% (131/133), 91.73% (122/133), 90.23% (120/133) and 90.23% (120/133), respectively). The drug resistance of different NTM strains to some drugs showed interspecific differences.

Key words: Mycobacteria, atypical, Bacterial typing techniques, Microbial sensitivity tests, Data interpretation, statistical

封彬彬, 金锋, 景辉, 王俊玲, 林美英, 乔秀丽, 李铭, 邱丽华. 山东地区439株非结核分枝杆菌临床分离株菌种鉴定及耐药情况[J]. 中国防痨杂志, 2021, 43(5): 516-520. doi: 10.3969/j.issn.1000-6621.2021.05.019

FENG Bin-bin, JIN Feng, JING Hui, WANG Jun-ling, LIN Mei-ying, QIAO Xiu-li, LI Ming, QIU Li-hua. Identification and drug resistance of 439 clinical isolates of non-tuberculosis mycobacterium in Shandong[J]. Chinese Journal of Antituberculosis, 2021, 43(5): 516-520. doi: 10.3969/j.issn.1000-6621.2021.05.019

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菌种	菌株数(株)	构成比(%)
胞内分枝杆菌	247	69.77
堪萨斯分枝杆菌	45	12.71
脓肿分枝杆菌	27	7.63
偶发分枝杆菌	13	3.67
龟分枝杆菌	8	2.26
鸟分枝杆菌	5	1.41
苏加分枝杆菌	2	0.57
耻垢分枝杆菌	2	0.57
戈登分枝杆菌	2	0.57
浅黄分枝杆菌	1	0.28
阿罗普分枝杆菌	1	0.28
新金色分枝杆菌	1	0.28

特征	胞内分枝杆菌 (247例)	堪萨斯分枝杆菌(45例)	脓肿分枝杆菌 (27例)	其他分枝杆菌 (35例)	合计 (354例)	χ²值	P值
性别						18.639	<0.01
男	166(67.21)	36(80.00)	9(33.33)	19(54.29)	230(64.97)
女	81(32.79)	9(20.00)	18(66.67)	16(45.71)	124(35.03)
年龄组(岁)						42.363	<0.01
<45	19(7.69)	16(35.56)	8(29.63)	11(31.43)	54(15.25)
45~60	90(36.44)	19(42.22)	8(29.63)	10(28.57)	127(35.88)
61~90	138(55.87)	10(22.22)	11(40.74)	14(40.00)	173(48.87)

药品	胞内分枝杆菌 (33株)	堪萨斯分枝杆菌 (9株)	偶发分枝杆菌 (4株)	鸟分枝杆菌 (2株)	龟分枝杆菌 (2株)	合计 (50株)
异烟肼	32(96.97)	7(7/9)	4(4/4)	2(2/2)	2(2/2)	47(94.00)
利福平	33(100.00)	2(2/9)	4(4/4)	2(2/2)	2(2/2)	43(86.00)
链霉素	32(96.97)	9(9/9)	4(4/4)	2(2/2)	2(2/2)	49(98.00)
乙胺丁醇	20(60.61)	0(0/9)	4(4/4)	1(1/2)	1(1/2)	26(52.00)
卷曲霉素	32(96.97)	7(7/9)	4(4/4)	2(2/2)	2(2/2)	47(94.00)
左氧氟沙星	33(100.00)	2(2/9)	4(4/4)	2(2/2)	2(2/2)	43(86.00)
对氨基水杨酸	33(100.00)	9(9/9)	4(4/4)	2(2/2)	2(2/2)	50(100.00)
阿米卡星	31(93.94)	9(9/9)	4(4/4)	2(2/2)	2(2/2)	48(96.00)
卡那霉素	31(93.94)	8(8/9)	4(4/4)	2(2/2)	2(2/2)	47(94.00)
氧氟沙星	33(100.00)	3(3/9)	4(4/4)	2(2/2)	2(2/2)	44(88.00)

药品	胞内分枝杆菌 (84株)	堪萨斯分枝杆菌 (14株)	脓肿分枝杆菌 (24株)	偶发分枝杆菌 (5株)	其他分枝杆菌 (6株)	合计 (133株)	χ²值	P值
利奈唑胺	69(82.14)	1(7.14)	0(0.00)	0(0.0)	2(2/6)	72(54.14)	67.821	0.000
克拉霉素	4(4.76)	1(7.14)	2(8.33)	1(1/5)	0(0.0)	8(6.02)	-	0.572^a
利福平	1(1.19)	0(0.0)	19(79.17)	4(4/5)	0(0.0)	24(18.05)	-	0.000^a
阿米卡星	1(1.19)	1(7.14)	2(8.33)	0(0.0)	1(1/6)	5(3.76)	-	0.125^a
亚胺培南/西司他丁	83(98.81)	14(100.00)	24(100.00)	4(4/5)	6(6/6)	131(98.50)	-	1.000^a
乙胺丁醇	34(40.48)	6(42.86)	24(100.00)	3(3/5)	2(2/6)	69(51.88)	27.104	0.000
头孢西丁	7(8.33)	12(85.71)	1(4.17)	1(1/5)	1(1/6)	22(16.54)	-	0.000^a
阿奇霉素	33(39.29)	4(28.57)	9(37.50)	3(3/5)	2(2/6)	51(38.35)	0.587	0.771
利福布汀	0(0.00)	0(0.00)	9(37.50)	0(0.0)	0(0.0)	9(6.77)	-	0.000^a
妥布霉素	24(28.57)	11(78.57)	23(95.83)	5(5/5)	5(5/6)	68(51.13)	39.968	0.000
加替沙星	54(64.29)	2(14.29)	20(83.33)	0(0.0)	5(5/6)	81(60.90)	18.402	0.000
莫西沙星	0(0.00)	0(0.00)	0(0.00)	0(0.0)	0(0.0)	0(0.00)
多西环素	79(94.05)	13(92.86)	22(91.67)	4(4/5)	4(4/6)	122(91.73)	-	0.858^a
米诺环素	81(96.43)	10(71.43)	21(87.50)	4(4/5)	4(4/6)	120(90.23)	-	0.006^a
复方磺胺甲噁唑	81(96.43)	9(64.29)	20(83.33)	5(5/5)	5(5/6)	120(90.23)	-	0.001^a