van Ingen J, Bendien S A, de Lange W C M, Hoefsloot W, Dekhuijzen P N R, Boeree M J, van Soolingen D
Department of Pulmonary Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Thorax. 2009 Jun;64(6):502-6. doi: 10.1136/thx.2008.110957. Epub 2009 Feb 12.
The frequency of clinical isolation of non-tuberculous mycobacteria (NTM) in the Netherlands is increasing, but its clinical relevance is often uncertain.
To assess the frequency and clinical relevance of isolation of NTM in four associated hospitals in a single region in the Netherlands.
Medical files of all patients from whom NTM were isolated between January 1999 and January 2005 were reviewed retrospectively. Diagnostic criteria for non-tuberculous mycobacterial disease published by the American Thoracic Society (ATS) were used to determine clinical relevance.
232 patients were found, from whom NTM were isolated from the respiratory tract in 91% of cases. Patients were mostly white men, with an average age of 60 years and pre-existing pulmonary disease. Fifty-three of 212 patients (25%) with pulmonary isolates met the ATS diagnostic criteria for pulmonary NTM disease; this percentage differed by species. Most patients were treated with rifampicin, ethambutol and clarithromycin. Treatment outcome for pulmonary NTM disease was suboptimal but differed by species: overall, improvement was seen in 67% of treated patients, but in only 50% of those with pulmonary M avium disease. Lymphadenitis was the most common extrapulmonary disease type.
Twenty-five per cent of all patients with pulmonary NTM isolates met the ATS criteria. Clinical relevance differs by species. NTM isolation increases over time. Species distribution differs from that of neighbouring countries and the M avium complex isolates have traits different from those reported in the USA. Adherence to diagnostic and treatment guidelines can be improved.
在荷兰，非结核分枝杆菌（NTM）的临床分离频率正在上升，但其临床相关性往往不确定。
评估荷兰单一地区四家相关医院中NTM分离的频率及其临床相关性。
回顾性分析1999年1月至2005年1月间所有分离出NTM的患者的病历。采用美国胸科学会（ATS）发布的非结核分枝杆菌病诊断标准来确定临床相关性。
共发现232例患者，其中91%的病例NTM是从呼吸道分离出来的。患者大多为白人男性，平均年龄60岁，且患有肺部疾病。212例肺部分离出NTM的患者中有53例（25%）符合ATS关于肺部NTM病的诊断标准；该百分比因菌种而异。大多数患者接受了利福平、乙胺丁醇和克拉霉素治疗。肺部NTM病的治疗效果欠佳，但因菌种而异：总体而言，67%的接受治疗的患者病情有所改善，但肺部鸟分枝杆菌病患者中只有50%病情改善。淋巴结炎是最常见的肺外疾病类型。
所有肺部分离出NTM的患者中有25%符合ATS标准。临床相关性因菌种而异。NTM分离率随时间增加。菌种分布与邻国不同，鸟分枝杆菌复合群分离株具有与美国报道不同的特征。对诊断和治疗指南的依从性有待提高。
