Division of Infectious Diseases, Department of Internal Medicine, Changhua Christian Hospital, Changhua 500, Taiwan.
J Microbiol Immunol Infect. 2009 Aug;42(4):343-50.
Infections due to rapidly growing mycobacteria (RGM) are increasing worldwide, especially in immunocompromised hosts, but data on the clinical features of patients with RGM bacteremia are limited in Taiwan. This study was performed to determine the features associated with RGM.
The medical records of 12 patients with RGM bacteremia admitted to the Changhua Christian Hospital, Changhua, Taiwan, from April 2001 to March 2003 were retrospectively studied. Clinical data were reviewed and antimicrobial susceptibility testing of blood isolates by the agar disk elution method was performed.
RGM bacteremia was caused by Mycobacterium fortuitum in 5 patients, Mycobacterium smegmatis in 3, Mycobacterium flavescens in 2, and Mycobacterium abscessus in 2. There were 5 men and 7 women (age range, 4-75 years). All patients had underlying diseases and all of the infections were associated with an indwelling vascular catheter. The time to onset of bacteremia ranged from 1 to 24 months. Fever (n = 11) was the most common presenting symptom. Susceptibility testing revealed a different antibiogram for each species of RGM. The rate of relapsing bacteremia was significantly higher in patients with delayed catheter removal and for whom the catheter was not removed (6/8; 75%) than in patients with timely catheter removal (0/4; 0%) [p = 0.03].
RGM bacteremia is rare but should be considered in immunocompromised patients with an indwelling venous catheter and undifferentiated fever. Identifying RGM at the species level and performing susceptibility testing are useful for guiding management. The catheter should be removed as soon as possible.
快速生长分枝杆菌（RGM）引起的感染在全球范围内不断增加，尤其是在免疫功能低下的宿主中，但有关 RGM 菌血症患者临床特征的数据在台湾有限。本研究旨在确定与 RGM 相关的特征。
回顾性研究了 2001 年 4 月至 2003 年 3 月期间在台湾彰化基督教医院因 RGM 菌血症入院的 12 名患者的病历。回顾了临床数据，并通过琼脂盘洗脱法对血培养分离株进行了抗菌药物敏感性测试。
RGM 菌血症由偶然分枝杆菌引起 5 例，由耻垢分枝杆菌引起 3 例，由微黄分枝杆菌引起 2 例，由脓肿分枝杆菌引起 2 例。患者年龄 4-75 岁，男 5 例，女 7 例。所有患者均有基础疾病，所有感染均与留置血管导管有关。菌血症发病时间为 1-24 个月。发热（n=11）是最常见的首发症状。药敏试验显示每种 RGM 均具有不同的药敏谱。导管延迟拔出且未拔出（6/8；75%）的患者复发菌血症的发生率明显高于及时拔出导管（0/4；0%）的患者（p=0.03）。
RGM 菌血症虽罕见，但免疫功能低下、留置静脉导管和未分化发热的患者应考虑该诊断。确定 RGM 的种属水平并进行药敏试验有助于指导治疗。应尽快拔除导管。
