中国的非结核分枝杆菌：一项全国性调查的发病率和抗菌药物耐药谱。
Nontuberculous mycobacteria in China: incidence and antimicrobial resistance spectrum from a nationwide survey.
机构信息
National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Changbai Road 155, Changping, Beijing102206, China.
National Center of Gerontology, Beijing Hospital, Dongdandahua Road 1, Dongcheng, Beijing, 100730, China.
出版信息
Infect Dis Poverty. 2021 Apr 29;10(1):59. doi: 10.1186/s40249-021-00844-1.
BACKGROUND
Information on the prevalence and resistance spectrum of nontuberculous mycobacteria (NTM) in China is mainly based on regional or local data. To estimate the proportion of NTM cases in China, a national survey of NTM pulmonary disease was carried out based on acid-fast positive sputum samples collected in 2013.
METHODS
Sputum samples collected from enrolled presumptive cases in 72 nationwide tuberculosis surveillance sites from the 31 provinces in the mainland of China were cultured using L-J medium at the National tuberculosis reference laboratory (NTRL). MALDI-TOF MS identified the species of re-cultured strains, and minimal inhibitory concentrations (MICs) were determined to evaluate the drug susceptibility of NTM isolates. Data analysis used statistical software SPSS version 22.0 for Windows statistical package.
RESULTS
Of 4917 mycobacterial isolates cultured, 6.4% [317/4917, 95% confidence interval (CI) 5.8%-7.2%] were confirmed as NTM, among which 7.7% (287/3709, 95% CI 6.9%-8.6%) were from the southern region. In inland and coastal China, 87.7% (95% CI 78.7%-93.2%) and 50.0% (95% CI 43.7%-56.3%) of isolates, respectively, were slow-growing mycobacteria (SGM), with the remaining rapid growing mycobacteria (RGM). A total of 29 species were detected, Mycobacterium abscessus had higher clarithromycin-inducible resistance rates than M. massiliense (65.67% vs 2.22%). M. kansasii presented lower resistance rates in linezolid and moxifloxacin than M. avium-intracellulare complex (3.23% vs 66.67%, 0 vs 47.22%) and other SGM (3.23% vs 38%, 0 vs 26%).
CONCLUSIONS
More NTM pulmonary disease was observed in the south and coastal China (P < 0.01). SGM was widely distributed, and more RGM are present in southern and coastal China (P < 0.01). The antimicrobial resistance spectrum of different NTM species was significantly different and accurate species identification would be facilitated to NTM pulmonary disease treatment.
背景
中国非结核分枝杆菌（NTM）的流行情况和耐药谱主要基于区域性或地方性数据。为了估计中国 NTM 病例的比例，我们基于 2013 年收集的抗酸阳性痰标本，对全国 NTM 肺部疾病进行了一项全国性调查。
方法
在全国结核病参考实验室（NTRL），采用 L-J 培养基对来自中国大陆 31 个省 72 个全国结核病监测点纳入的疑似病例的痰标本进行培养。基质辅助激光解吸电离飞行时间质谱（MALDI-TOF MS）对再培养菌株进行种属鉴定，测定最小抑菌浓度（MIC）以评估 NTM 分离株的药敏情况。数据分析采用 Windows 统计软件包 SPSS 版本 22.0。
结果
共培养出 4917 株分枝杆菌，6.4%（317/4917，95%置信区间[CI]5.8%-7.2%）被确认为 NTM，其中南方地区占 7.7%（287/3709，95%CI 6.9%-8.6%）。内陆和沿海地区，87.7%（95%CI 78.7%-93.2%）和 50.0%（95%CI 43.7%-56.3%）的分离株分别为生长缓慢的分枝杆菌（SGM），其余为快速生长分枝杆菌（RGM）。共检出 29 个种，脓肿分枝杆菌的克拉霉素诱导耐药率高于马赛分枝杆菌（65.67%比 2.22%）。堪萨斯分枝杆菌对利奈唑胺和莫西沙星的耐药率低于禽分枝杆菌复合群（3.23%比 66.67%，0 比 47.22%）和其他 SGM（3.23%比 38%，0 比 26%）。
结论
中国南方和沿海地区 NTM 肺病的发病率较高（P<0.01）。SGM 分布广泛，南方和沿海地区 RGM 较多（P<0.01）。不同 NTM 种的抗菌药物耐药谱差异显著，有助于 NTM 肺病的治疗。
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